Provider Demographics
NPI:1568976090
Name:SCOTT, JULIE LILLIAN (CBD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LILLIAN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FAIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2308
Mailing Address - Country:US
Mailing Address - Phone:631-655-8156
Mailing Address - Fax:631-591-0233
Practice Address - Street 1:30 FAIRWAY AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2308
Practice Address - Country:US
Practice Address - Phone:631-655-8156
Practice Address - Fax:631-591-0233
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula