Provider Demographics
NPI:1013072008
Name:BLEAKLEY, SCOTT THOMAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:THOMAS
Last Name:BLEAKLEY
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 1:160 LAFAYETTE RD APT 1
Mailing Address - Street 2:
Mailing Address - City:NORTH HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03862-2420
Mailing Address - Country:US
Mailing Address - Phone:603-370-0168
Mailing Address - Fax:
Practice Address - Street 1:1530 CELEBRATION BLVD STE 405
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5165
Practice Address - Country:US
Practice Address - Phone:833-769-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10711041C0700X
FLSW214411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30423171Medicaid
MAP08033OtherBCBS
NH144001431NH02OtherBCBS
NH30423171Medicaid