Provider Demographics
NPI:1891132676
Name:GREENSPAN, SCOTT BRANDON (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRANDON
Last Name:GREENSPAN
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 1:50 LEWIS ST APT 219
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2776
Mailing Address - Country:US
Mailing Address - Phone:781-801-2543
Mailing Address - Fax:
Practice Address - Street 1:50 LEWIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2784
Practice Address - Country:US
Practice Address - Phone:781-801-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11878103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist