Provider Demographics
NPI:1376116368
Name:ADAMS, SCOTT R
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:ADAMS
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 1:957 GULFSTREAM AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6028
Mailing Address - Country:US
Mailing Address - Phone:772-205-8025
Mailing Address - Fax:
Practice Address - Street 1:1515 INDIAN RIVER BLVD STE A210
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7107
Practice Address - Country:US
Practice Address - Phone:772-774-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-175965106S00000X
1-23-64220103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician