MEDICARE: DR. SCOTT CARLSON PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS008542L	PA

General Provider Information

NPI Number	:	1083765580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT CARLSON PSYD

Provider Business Mailing Address
First Line	:	327 ROCKHILL RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15243-1411
Country	:	US
Telephone Number	:	412-319-7148
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 ROCKFIELD CIR
Second Line	:	WPIC-BT4
City	:	PITTSBURGH
State	:	PA
Zip	:	15243-1406
Country	:	US
Telephone Number	:	412-246-5407
Fax Number	:	412-246-5410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2007
Last Update Date	:	03/30/2017

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