Provider Demographics
NPI:1629286034
Name:MATHIAS, SCOTT A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:MATHIAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5426
Mailing Address - Country:US
Mailing Address - Phone:570-322-5051
Mailing Address - Fax:570-322-6788
Practice Address - Street 1:1521 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5426
Practice Address - Country:US
Practice Address - Phone:570-322-5051
Practice Address - Fax:570-322-6788
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017381103TC0700X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist