Provider Demographics
NPI:1255737862
Name:SCOTT, TIMOTHY DAVID (LICSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DAVID
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:MA
Mailing Address - Zip Code:01341-0052
Mailing Address - Country:US
Mailing Address - Phone:413-320-7071
Mailing Address - Fax:
Practice Address - Street 1:111 COUNTY CIR
Practice Address - Street 2:MIDDLESEX HOUSE, ROOM 205
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9255
Practice Address - Country:US
Practice Address - Phone:413-545-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1141901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA114190OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER