Healthcare Provider Details

I. General information

NPI: 1013072008
Provider Name (Legal Business Name): SCOTT THOMAS BLEAKLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 CELEBRATION BLVD STE 405
CELEBRATION FL
34747-5165
US

IV. Provider business mailing address

1530 CELEBRATION BLVD STE 405
CELEBRATION FL
34747-5165
US

V. Phone/Fax

Practice location:
  • Phone: 833-769-3524
  • Fax:
Mailing address:
  • Phone: 833-769-3524
  • Fax: 321-233-9959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21441
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1071
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: