Provider Demographics
NPI:1326745118
Name:ENTZI, SCOTT (MED)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:ENTZI
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 SHADYDALE DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9655
Mailing Address - Country:US
Mailing Address - Phone:330-519-4991
Mailing Address - Fax:
Practice Address - Street 1:1705 WOODLAND ST NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5348
Practice Address - Country:US
Practice Address - Phone:330-469-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician