Provider Demographics
NPI:1497187579
Name:SCOTT, JOLINE (MA EDM LPC)
Entity Type:Individual
Prefix:MS
First Name:JOLINE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MA EDM LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4841
Mailing Address - Country:US
Mailing Address - Phone:860-870-0119
Mailing Address - Fax:
Practice Address - Street 1:428 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4841
Practice Address - Country:US
Practice Address - Phone:860-657-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional