Healthcare Provider Details

I. General information

NPI: 1083772321
Provider Name (Legal Business Name): AMANDA N SCOTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 CISCO CIR
CORPUS CHRISTI TX
78413-6117
US

IV. Provider business mailing address

7701 CISCO CIR
CORPUS CHRISTI TX
78413-6117
US

V. Phone/Fax

Practice location:
  • Phone: 757-773-3838
  • Fax:
Mailing address:
  • Phone: 757-773-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11854
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61806
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: