1144262312 NPI number — MR. DOMINIC LEONARD SCOTTO LCSW

Table of content: MR. DOMINIC LEONARD SCOTTO LCSW (NPI 1144262312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144262312 NPI number — MR. DOMINIC LEONARD SCOTTO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTTO
Provider First Name:
DOMINIC
Provider Middle Name:
LEONARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144262312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 WHITMAN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-4331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-780-0410
Provider Business Mailing Address Fax Number:
120-988-5644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WOODLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07748-3438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-216-2067
Provider Business Practice Location Address Fax Number:
209-885-6448
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC00363500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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