Provider Demographics
NPI:1194397463
Name:BOUTSIKARIS, SCOTT PETER
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:PETER
Last Name:BOUTSIKARIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4507
Mailing Address - Country:US
Mailing Address - Phone:732-887-9329
Mailing Address - Fax:
Practice Address - Street 1:113 LINDA LN
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-4507
Practice Address - Country:US
Practice Address - Phone:732-887-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool