=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598284929
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. SCOTT J. MCALLISTER SR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2017
-----------------------------------------------------
Last Update Date | 08/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 N MAIN ST BLDG 9A
-----------------------------------------------------
City | LEEDS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01053-9796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-949-2320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 N MAIN ST BLDG 9A
-----------------------------------------------------
City | LEEDS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01053-9796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-634-6839
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------