Provider Demographics
NPI:1699014688
Name:SCOTT DAVID LIFF
Entity Type:Organization
Organization Name:SCOTT DAVID LIFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LSCW
Authorized Official - Phone:845-661-8002
Mailing Address - Street 1:1123 BROADWAY
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2007
Mailing Address - Country:US
Mailing Address - Phone:845-661-8002
Mailing Address - Fax:845-628-2777
Practice Address - Street 1:1123 BROADWAY
Practice Address - Street 2:SUITE 1205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2007
Practice Address - Country:US
Practice Address - Phone:845-661-8002
Practice Address - Fax:845-628-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0775971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty