Provider Demographics
NPI:1437365525
Name:LAURENCE, SCOTT (MED, PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:LAURENCE
Suffix:
Gender:M
Credentials:MED, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11668 PIPING PLOVER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-5846
Mailing Address - Country:US
Mailing Address - Phone:561-798-6604
Mailing Address - Fax:
Practice Address - Street 1:11668 PIPING PLOVER RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-5846
Practice Address - Country:US
Practice Address - Phone:561-798-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50164OtherCERTIFIED MENTAL HEALTH
FL9930OtherSTATE OF FLORIDA LICENSED MENTAL HEALTH COUNSELOR