Provider Demographics
NPI:1871837922
Name:SCOTT, CHRISTIAN ADAM (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ADAM
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SPRING ST
Mailing Address - Street 2:JEFFERSON ACADEMIC CENTER
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1817
Mailing Address - Country:US
Mailing Address - Phone:631-476-0564
Mailing Address - Fax:
Practice Address - Street 1:118 SPRING ST
Practice Address - Street 2:JEFFERSON ACADEMIC CENTER
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1817
Practice Address - Country:US
Practice Address - Phone:631-476-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0715571041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical