Provider Demographics
NPI:1821621558
Name:DELLERT, SCOTT LUIS
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LUIS
Last Name:DELLERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 FORT WASHINGTON AVE APT 5D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3908
Mailing Address - Country:US
Mailing Address - Phone:347-982-5445
Mailing Address - Fax:
Practice Address - Street 1:660 FORT WASHINGTON AVE APT 5D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3908
Practice Address - Country:US
Practice Address - Phone:347-982-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician