Healthcare Provider Details

I. General information

NPI: 1588025001
Provider Name (Legal Business Name): MR. SCOTT WILLIAM MENASCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W 10TH ST
ANTIOCH CA
94509-1653
US

IV. Provider business mailing address

865 MITCHELL AVE
OROVILLE CA
95965-4646
US

V. Phone/Fax

Practice location:
  • Phone: 925-777-9540
  • Fax:
Mailing address:
  • Phone: 530-538-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number111342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: