Provider Demographics
NPI:1356595359
Name:SCOTT, SALLY ANN (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BALDWIN GREEN COMMON
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:781-932-0257
Mailing Address - Fax:781-932-6727
Practice Address - Street 1:3 BALDWIN GREEN COMMON
Practice Address - Street 2:SUITE 303
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-932-0257
Practice Address - Fax:781-932-6727
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10183251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical