Healthcare Provider Details

I. General information

NPI: 1811097975
Provider Name (Legal Business Name): LISBETH ANN SCOTT MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SAINT JOE CENTER RD #44
FORT WAYNE IN
46825-5000
US

IV. Provider business mailing address

1910 SAINT JOE CENTER RD #44
FORT WAYNE IN
46825-5000
US

V. Phone/Fax

Practice location:
  • Phone: 260-471-8033
  • Fax: 260-471-8107
Mailing address:
  • Phone: 260-471-8033
  • Fax: 260-471-8107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34000244A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: