Provider Demographics
NPI:1912062704
Name:SCOTT, MICHAEL JOHN (PSYD, ABN)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PSYD, ABN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221446
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33022-1446
Mailing Address - Country:US
Mailing Address - Phone:786-202-6273
Mailing Address - Fax:
Practice Address - Street 1:5700 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6350
Practice Address - Country:US
Practice Address - Phone:786-202-6273
Practice Address - Fax:954-628-8647
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5960103G00000X
NYNY011875-1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist