Provider Demographics
NPI:1700901899
Name:SCOTT, MARJORIE LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:LOUISE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 BROOKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2658
Mailing Address - Country:US
Mailing Address - Phone:248-647-3576
Mailing Address - Fax:
Practice Address - Street 1:950 WEST MAPLE RD.
Practice Address - Street 2:#214
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009
Practice Address - Country:US
Practice Address - Phone:248-540-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006257103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI62OF34917Medicare UPIN
MIOF34917Medicare PIN