Provider Demographics
NPI:1326510777
Name:SCOTT, JUSTIN GREGORY
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GREGORY
Last Name:SCOTT
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 1:49 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3113
Mailing Address - Country:US
Mailing Address - Phone:203-722-9920
Mailing Address - Fax:
Practice Address - Street 1:49 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3113
Practice Address - Country:US
Practice Address - Phone:203-722-9920
Practice Address - Fax:651-855-5176
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-33290OtherBACB