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General NPI Number Information
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NPI Number | 1891132676
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Entity Type | Individual
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Provider Name | SCOTT BRANDON GREENSPAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 50 LEWIS ST
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City | BOSTON
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State | MA
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Zip | 02128-2784
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Country | US
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Telephone | 781-801-2543
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Fax |
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Provider Business Mailing Address
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Address Line | 50 LEWIS ST APT 219
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City | EAST BOSTON
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State | MA
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Zip | 02128-2776
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Country | US
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Telephone | 781-801-2543
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 11878
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License Number State | MA
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