Provider Demographics
NPI:1336485465
Name:BANFORD, SCOTT M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:M
Last Name:BANFORD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 ANDERSON AVE
Mailing Address - Street 2:12-K
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2702
Mailing Address - Country:US
Mailing Address - Phone:201-242-0221
Mailing Address - Fax:201-242-0221
Practice Address - Street 1:1590 ANDERSON AVE
Practice Address - Street 2:12-K
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2702
Practice Address - Country:US
Practice Address - Phone:201-242-0221
Practice Address - Fax:201-242-0221
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC050108001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical