Provider Demographics
NPI:1376717710
Name:DAVIS, SCOTT JOHNSTON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JOHNSTON
Last Name:DAVIS
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:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:ME
Mailing Address - Zip Code:04040-0768
Mailing Address - Country:US
Mailing Address - Phone:207-647-5151
Mailing Address - Fax:
Practice Address - Street 1:82 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1128
Practice Address - Country:US
Practice Address - Phone:207-647-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC108341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical