Provider Demographics
NPI:1801096334
Name:BANDOROFF, SCOTT A (PSYCHOLOGIST (PHD))
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:BANDOROFF
Suffix:
Gender:M
Credentials:PSYCHOLOGIST (PHD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 503010
Mailing Address - Street 2:X
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-0813
Mailing Address - Country:US
Mailing Address - Phone:541-941-7792
Mailing Address - Fax:503-419-4662
Practice Address - Street 1:149 CLEAR CREEK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:541-951-4329
Practice Address - Fax:503-419-4662
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1120103TC2200X
OROR1120103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent