Healthcare Provider Details

I. General information

NPI: 1093778573
Provider Name (Legal Business Name): SCOTT NELSON JONES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMHCS, PERRY POINT DIVISION, AVENUE D
PERRY POINT MD
21902
US

IV. Provider business mailing address

VAMHCS, PERRY POINT DIVISION, AVENUE D BUILDING 80, #129A
PERRY POINT MD
21902
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax: 410-642-1150
Mailing address:
  • Phone: 410-642-2411
  • Fax: 410-642-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number02725
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number02725
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: