=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689540452
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE SCOTT LCADC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2025
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 984 BERGEN AVE
-----------------------------------------------------
City | NORTH BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08902-2335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-993-6403
-----------------------------------------------------
Fax | 732-626-4544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 LAKEWOOD PL
-----------------------------------------------------
City | PORT MONMOUTH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07758-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-993-6403
-----------------------------------------------------
Fax | 732-626-4544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 44SL06795100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 44SL06795100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------