Provider Demographics
NPI:1568053205
Name:SCOTT, STACY LEIGH (EDD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:LEIGH
Last Name:SCOTT
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02642-3058
Mailing Address - Country:US
Mailing Address - Phone:617-750-3134
Mailing Address - Fax:
Practice Address - Street 1:185 ALSTON AVE
Practice Address - Street 2:
Practice Address - City:EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02642-3058
Practice Address - Country:US
Practice Address - Phone:617-750-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6508103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist