Provider Demographics
NPI:1821110727
Name:SCOTT, RICHARD MALACHI (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MALACHI
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11672 RAMSDELL CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3607
Mailing Address - Country:US
Mailing Address - Phone:619-405-6422
Mailing Address - Fax:
Practice Address - Street 1:10755 SCRIPPS POWAY PKWY
Practice Address - Street 2:STE #173
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3924
Practice Address - Country:US
Practice Address - Phone:619-405-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19143103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP19143AMedicare ID - Type Unspecified