=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598629396
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLENN SCOTT LIVINGSTON PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2025
-----------------------------------------------------
Last Update Date | 12/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 N OCEAN BLVD APT 412
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-4603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-490-3844
-----------------------------------------------------
Fax | 516-706-0475
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 N OCEAN BLVD APT 412
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-4603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-490-3844
-----------------------------------------------------
Fax | 516-706-0475
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY12245
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------