MEDICARE: VERONICA CARMEN ALYSIAH SCOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1134997679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA CARMEN ALYSIAH SCOTT

Provider Business Mailing Address
First Line	:	65 MOUNT VERNON ST
Second Line	:
City	:	FITCHBURG
State	:	MA
Zip	:	01420-3373
Country	:	US
Telephone Number	:	978-790-4034
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 MOUNT VERNON ST
Second Line	:
City	:	FITCHBURG
State	:	MA
Zip	:	01420-3373
Country	:	US
Telephone Number	:	978-790-4034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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