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General NPI Number Information
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NPI Number | 1649359084
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Entity Type | Individual
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Provider Name | JEROME ROSEMON SCOTT JR. LMFT
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Gender | Male
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3595 UNIVERSITY AVE STE E
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City | RIVERSIDE
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State | CA
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Zip | 92501-3343
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Country | US
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Telephone | 951-454-5632
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Fax | 951-736-9672
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Provider Business Mailing Address
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Address Line | 3099 VERMONT DR
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City | CORONA
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State | CA
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Zip | 92881-8313
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Country | US
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Telephone | 951-454-5632
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Fax | 951-736-9672
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT 40147
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License Number State | CA
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