Provider Demographics
NPI:1649359084
Name:SCOTT, JEROME ROSEMON JR (LMFT)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:ROSEMON
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:JEROME
Other - Middle Name:ROSEMON
Other - Last Name:SCOTT
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:3099 VERMONT DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8313
Mailing Address - Country:US
Mailing Address - Phone:951-454-5632
Mailing Address - Fax:951-736-9672
Practice Address - Street 1:3595 UNIVERSITY AVE STE E
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3343
Practice Address - Country:US
Practice Address - Phone:951-454-5632
Practice Address - Fax:951-736-9672
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 40147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist