Provider Demographics
NPI:1689156705
Name:SCOTT, LILLIAN (MSED)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13B DEFOE PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2103
Mailing Address - Country:US
Mailing Address - Phone:718-671-4492
Mailing Address - Fax:
Practice Address - Street 1:13B DEFOE PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2103
Practice Address - Country:US
Practice Address - Phone:718-671-4492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist