Provider Demographics
NPI:1962484964
Name:MIGDOLE, SCOTT J (LCSW)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:MIGDOLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CHURCH ST
Mailing Address - Street 2:YALE BEHAVIORAL HEALTH - SUITE 404
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3014
Mailing Address - Country:US
Mailing Address - Phone:203-288-6253
Mailing Address - Fax:203-288-0948
Practice Address - Street 1:55 CHURCH ST
Practice Address - Street 2:YALE BEHAVIORAL HEALTH - SUITE 404
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3014
Practice Address - Country:US
Practice Address - Phone:203-288-6253
Practice Address - Fax:203-288-0948
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004086104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004167715Medicaid
CT800001837Medicare ID - Type Unspecified