Provider Demographics
NPI:1770886913
Name:SCOTT, ANDREW L III (LCSW, CSAC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:L
Last Name:SCOTT
Suffix:III
Gender:M
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-652 HANILE ST
Mailing Address - Street 2:D107
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4629
Mailing Address - Country:US
Mailing Address - Phone:808-277-6130
Mailing Address - Fax:
Practice Address - Street 1:95-652 HANILE ST
Practice Address - Street 2:D107
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-4629
Practice Address - Country:US
Practice Address - Phone:808-277-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HICSAC 1283-06101YA0400X
HILCSW 3640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN