Provider Demographics
NPI:1255773818
Name:SCOTT, KENNETH
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 2ND AVE #15-F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:917-573-4489
Mailing Address - Fax:212-725-8223
Practice Address - Street 1:490 2ND AVE APT 15F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9178
Practice Address - Country:US
Practice Address - Phone:917-573-4489
Practice Address - Fax:212-725-8223
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721496174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY721496OtherSTUDENTS WITH DISABILITIES (BIRTH-GRADES 2)