Provider Demographics
NPI:1255007027
Name:ALLEN, SCOTT W (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11745 KIMMIE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3701
Mailing Address - Country:US
Mailing Address - Phone:954-447-3739
Mailing Address - Fax:
Practice Address - Street 1:11745 KIMMIE DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-3701
Practice Address - Country:US
Practice Address - Phone:954-447-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3979103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical