Provider Demographics
NPI:1790983849
Name:SCOTT, CRAIG DANA (MSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:DANA
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-3739
Mailing Address - Country:US
Mailing Address - Phone:317-797-4138
Mailing Address - Fax:
Practice Address - Street 1:2626 E 46TH ST STE J
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2373
Practice Address - Country:US
Practice Address - Phone:317-475-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IN33005314A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)