Provider Demographics
NPI:1184856510
Name:HARVEY, J. SCOTT (LCSW)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:SCOTT
Last Name:HARVEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:SCOTT
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:30 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5748
Mailing Address - Country:US
Mailing Address - Phone:203-326-1401
Mailing Address - Fax:
Practice Address - Street 1:30 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5748
Practice Address - Country:US
Practice Address - Phone:203-326-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006873104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236338Medicaid
CT004236338Medicaid