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General NPI Number Information
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NPI Number | 1235505199
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Entity Type | Individual
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Provider Name | BRIAN SCOTT LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 5139 DEER PARK DR
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-7013
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Country | US
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Telephone | 727-372-1854
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Fax |
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Provider Business Mailing Address
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Address Line | 3252 AVON CT
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City | LAND O LAKES
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State | FL
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Zip | 34639-4701
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Country | US
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Telephone | 561-212-6637
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW13949
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License Number State | FL
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