Provider Demographics
NPI:1922542802
Name:SCOTT, CAROLYN A (SST)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26740 LATHRUP BLVD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4633
Mailing Address - Country:US
Mailing Address - Phone:313-999-4214
Mailing Address - Fax:
Practice Address - Street 1:26740 LATHRUP BLVD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-4633
Practice Address - Country:US
Practice Address - Phone:313-999-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803086882104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker