Provider Demographics
NPI:1962489708
Name:SCOTT, CRAIG (LCSW)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:SCOTT
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 1:51 GLASGOW AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6413
Mailing Address - Country:US
Mailing Address - Phone:716-664-8640
Mailing Address - Fax:716-664-8607
Practice Address - Street 1:51 GLASGOW AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6413
Practice Address - Country:US
Practice Address - Phone:716-664-8640
Practice Address - Fax:716-664-8607
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD3907Medicare ID - Type Unspecified
NYP76900Medicare UPIN