MEDICARE: ANTOINE JEROME 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	101YA0400X	Addiction (Substance Use Disorder) Counselor		OH
2	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1861211302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINE JEROME SCOTT

Provider Business Mailing Address
First Line	:	321 W NORMAN AVE APT 1
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-3344
Country	:	US
Telephone Number	:	937-344-2168
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ELIZABETH PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-3445
Country	:	US
Telephone Number	:	937-813-1737
Fax Number	:

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

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	12/08/2025

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Directions to “ ANTOINE JEROME SCOTT ” Practice Location

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