Provider Demographics
NPI:1790430320
Name:SCOTT, DANNIELE NICOLE
Entity Type:Individual
Prefix:
First Name:DANNIELE
Middle Name:NICOLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 HUNT CLUB ST
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-4987
Mailing Address - Country:US
Mailing Address - Phone:850-240-7836
Mailing Address - Fax:
Practice Address - Street 1:1721 HUNT CLUB ST
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-4987
Practice Address - Country:US
Practice Address - Phone:850-240-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical