Provider Demographics
NPI:1467551226
Name:ALTABET, SCOTT S (LCSW)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:S
Last Name:ALTABET
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 708
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-0708
Mailing Address - Country:US
Mailing Address - Phone:917-208-4273
Mailing Address - Fax:718-904-9648
Practice Address - Street 1:2436 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5916
Practice Address - Country:US
Practice Address - Phone:917-208-4273
Practice Address - Fax:914-713-0337
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0327171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04973328Medicaid