Provider Demographics
NPI:1417734260
Name:GARVEY, SCOTT DOUGLAS (SUDCC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DOUGLAS
Last Name:GARVEY
Suffix:
Gender:M
Credentials:SUDCC
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 1109
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-0110
Mailing Address - Country:US
Mailing Address - Phone:925-646-9270
Mailing Address - Fax:925-646-9276
Practice Address - Street 1:4645 PACHECO BLVD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3625
Practice Address - Country:US
Practice Address - Phone:925-646-9270
Practice Address - Fax:925-646-9276
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7030101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)