Provider Demographics
NPI:1336525328
Name:BECKETT, SCARLETT (RCSWI)
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:
Last Name:BECKETT
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S ORCHARD ST APT 7C
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8404
Mailing Address - Country:US
Mailing Address - Phone:586-381-0529
Mailing Address - Fax:
Practice Address - Street 1:900 N SWALLOW TAIL DR STE 105
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6103
Practice Address - Country:US
Practice Address - Phone:386-333-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW180731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical