Provider Demographics
NPI:1235883687
Name:SCOTT, DOMINICQUE (RBT)
Entity Type:Individual
Prefix:
First Name:DOMINICQUE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-0962
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1819 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-6005
Practice Address - Country:US
Practice Address - Phone:908-217-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician