Provider Demographics
NPI:1275207698
Name:SCOTT, STEPHANIE ALMA (RBT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALMA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 KERNAN BLVD S STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-3605
Mailing Address - Country:US
Mailing Address - Phone:904-900-1664
Mailing Address - Fax:
Practice Address - Street 1:3503 KERNAN BLVD S STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-3605
Practice Address - Country:US
Practice Address - Phone:904-900-1664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-167442106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician