Provider Demographics
NPI:1952421521
Name:HOWARD, SCOTT EDWARD (EDD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:EDWARD
Last Name:HOWARD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 W ROBINHOOD DR
Mailing Address - Street 2:STE B2
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5517
Mailing Address - Country:US
Mailing Address - Phone:209-468-2385
Mailing Address - Fax:
Practice Address - Street 1:1341 W ROBINHOOD DR
Practice Address - Street 2:STE B2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5517
Practice Address - Country:US
Practice Address - Phone:209-468-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23896103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist