Provider Demographics
NPI:1932126430
Name:SIGMON, SCOTT B (EDD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:SIGMON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 MORRIS AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3526
Mailing Address - Country:US
Mailing Address - Phone:908-686-7555
Mailing Address - Fax:908-686-7555
Practice Address - Street 1:1945 MORRIS AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3526
Practice Address - Country:US
Practice Address - Phone:908-686-7555
Practice Address - Fax:908-686-7555
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI002772103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5092108Medicaid
709235Medicare ID - Type Unspecified