Provider Demographics
NPI:1902034986
Name:MACGREGOR, SCOTT (PSYD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MACGREGOR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 WETHERSFIELD AVE
Mailing Address - Street 2:ADULT SERVICES
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-1420
Mailing Address - Country:US
Mailing Address - Phone:860-236-4511
Mailing Address - Fax:
Practice Address - Street 1:331 WETHERSFIELD AVE
Practice Address - Street 2:ADULT SERVICES
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1420
Practice Address - Country:US
Practice Address - Phone:860-236-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003529103T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCPH003609Medicaid