Healthcare Provider Details

I. General information

NPI: 1396662623
Provider Name (Legal Business Name): MS. ELIZABETH CHIEMEKA SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 PENFIELD ST
BRONX NY
10470-1320
US

IV. Provider business mailing address

741 PENFIELD ST
BRONX NY
10470-1320
US

V. Phone/Fax

Practice location:
  • Phone: 917-603-8686
  • Fax:
Mailing address:
  • Phone: 917-603-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number553070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: