Provider Demographics
NPI:1205047198
Name:SCOTT, MATTHEW A (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13390 SW DAVIES RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6807
Mailing Address - Country:US
Mailing Address - Phone:503-858-0876
Mailing Address - Fax:
Practice Address - Street 1:7080 SW FIR LOOP
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8149
Practice Address - Country:US
Practice Address - Phone:503-620-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6600094-35011041C0700X
ORL44831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical