Provider Demographics
NPI:1942342274
Name:SCOTT, AMY NICOLE (PHD NCSP)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:NICOLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHD NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 QUINAN ST STE 200B
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1621
Mailing Address - Country:US
Mailing Address - Phone:480-363-4633
Mailing Address - Fax:
Practice Address - Street 1:668 QUINAN ST STE 200B
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1621
Practice Address - Country:US
Practice Address - Phone:480-363-4633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3949103TC0700X
AZ103TS0200X
CA24824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool