MEDICARE: SHANE SCOTT

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1427837301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANE SCOTT

Provider Business Mailing Address
First Line	:	1123-1125 NEW BRITAIN AVENUE
Second Line	:	SUITE 202
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-2454
Country	:	US
Telephone Number	:	860-604-4756
Fax Number	:

Provider Business Practice Location Address
First Line	:	1123-1125 NEW BRITAIN AVENUE
Second Line	:	SUITE 202
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-2454
Country	:	US
Telephone Number	:	860-604-4756
Fax Number	:

Authorized Official
Title or Position	:	LCSW/OWNER
Name	:	SHANE SCOTT
Credential	:	LCSW
Telephone Number	:	860-604-4756

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	05/24/2024

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