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General NPI Number Information
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NPI Number | 1154276301
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Entity Type | Individual
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Provider Name | SCOTT ELLIS BOOTH SCHOOL PSYCHOLOGY
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Gender | Male
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 1108 BISSELL AVE
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City | RICHMOND
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State | CA
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Zip | 94801-3135
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Country | US
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Telephone | 415-359-3531
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Fax |
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Provider Business Mailing Address
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Address Line | 955 CLAYTON ST APT 4
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City | SAN FRANCISCO
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State | CA
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Zip | 94117-4470
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Country | US
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Telephone | 415-359-3531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 210105200
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License Number State | CA
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