Provider Demographics
NPI:1497807994
Name:FAIRCHILD, L. SCOTT (PSY D)
Entity Type:Individual
Prefix:DR
First Name:L.
Middle Name:SCOTT
Last Name:FAIRCHILD
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 BEDFORD DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1993
Mailing Address - Country:US
Mailing Address - Phone:321-253-8887
Mailing Address - Fax:321-253-8878
Practice Address - Street 1:1370 BEDFORD DR
Practice Address - Street 2:SUITE 106
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1993
Practice Address - Country:US
Practice Address - Phone:321-253-8887
Practice Address - Fax:321-253-8878
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6051103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54549AMedicare PIN