Healthcare Provider Details

I. General information

NPI: 1326510777
Provider Name (Legal Business Name): JUSTIN GREGORY SCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 HAMPTON RD
HAMDEN CT
06518-3113
US

IV. Provider business mailing address

715 FRENCHTOWN RD UNIT 3
BRIDGEPORT CT
06606-1360
US

V. Phone/Fax

Practice location:
  • Phone: 203-722-9920
  • Fax: 651-855-5176
Mailing address:
  • Phone: 203-722-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3943
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number750
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: