Healthcare Provider Details

I. General information

NPI: 1609719913
Provider Name (Legal Business Name): RICHARD BERNARD SCOTT JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WERTZ AVE NW
CANTON OH
44708-4171
US

IV. Provider business mailing address

393 SLATE RIDGE DR
BARBERTON OH
44203-8608
US

V. Phone/Fax

Practice location:
  • Phone: 330-714-7035
  • Fax:
Mailing address:
  • Phone: 330-714-7035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberPRS.007590
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: