Provider Demographics
NPI:1679712228
Name:CEDENO, SCOTT V (LIC AC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:V
Last Name:CEDENO
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-2124
Mailing Address - Country:US
Mailing Address - Phone:888-917-9229
Mailing Address - Fax:
Practice Address - Street 1:1714 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-2124
Practice Address - Country:US
Practice Address - Phone:888-917-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233878171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist