Provider Demographics
NPI:1841618535
Name:JEFFERSON-SCOTT, CARLETTE
Entity Type:Individual
Prefix:
First Name:CARLETTE
Middle Name:
Last Name:JEFFERSON-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 1:863 BERKSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1979
Mailing Address - Country:US
Mailing Address - Phone:708-704-9274
Mailing Address - Fax:
Practice Address - Street 1:863 BERKSHIRE PL
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-1979
Practice Address - Country:US
Practice Address - Phone:708-704-9274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health