Provider Demographics
NPI:1326749961
Name:SCOTT, JUSTINE LORINA
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:LORINA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 CASCADE TRL
Mailing Address - Street 2:
Mailing Address - City:COOL
Mailing Address - State:CA
Mailing Address - Zip Code:95614-2425
Mailing Address - Country:US
Mailing Address - Phone:916-224-1227
Mailing Address - Fax:
Practice Address - Street 1:2603 CASCADE TRL
Practice Address - Street 2:
Practice Address - City:COOL
Practice Address - State:CA
Practice Address - Zip Code:95614-2425
Practice Address - Country:US
Practice Address - Phone:916-224-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician