Healthcare Provider Details

I. General information

NPI: 1346355740
Provider Name (Legal Business Name): THERESA MARIE SCOTT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 RIDGEBROOK RD STE 304
SPARKS MD
21152-9457
US

IV. Provider business mailing address

13 DEVONSHIRE DR
SHREWSBURY PA
17361-1131
US

V. Phone/Fax

Practice location:
  • Phone: 410-525-5333
  • Fax:
Mailing address:
  • Phone: 717-965-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS015867
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04444
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: