Provider Demographics
NPI:1578650495
Name:SCOTT, MASON B (PHD)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:B
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2771 SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-3146
Mailing Address - Country:US
Mailing Address - Phone:724-527-5104
Mailing Address - Fax:
Practice Address - Street 1:130 BIGELOW ST
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-2683
Practice Address - Country:US
Practice Address - Phone:724-527-5104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003485L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist