Provider Demographics
NPI:1588682694
Name:SCOTT, ROBERT TERRANCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TERRANCE
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18401 BURBANK BLVD
Mailing Address - Street 2:205
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2822
Mailing Address - Country:US
Mailing Address - Phone:818-996-5024
Mailing Address - Fax:
Practice Address - Street 1:18401 BURBANK BLVD
Practice Address - Street 2:205
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2822
Practice Address - Country:US
Practice Address - Phone:818-996-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7399103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000PSY7399OtherBLUE CROSS ID NUMBER