Provider Demographics
NPI:1851718696
Name:SCOTT, CAROLYN L
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:L
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 1:29 SUMMER HILL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2619
Mailing Address - Country:US
Mailing Address - Phone:802-591-0484
Mailing Address - Fax:603-357-9648
Practice Address - Street 1:17 93RD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3989
Practice Address - Country:US
Practice Address - Phone:603-283-1570
Practice Address - Fax:603-357-9648
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10000274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty