Provider Demographics
NPI:1679722987
Name:SCOTT, BRIAN L (MA,CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HAVEN PLZ
Mailing Address - Street 2:APT. 4E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3904
Mailing Address - Country:US
Mailing Address - Phone:212-614-0881
Mailing Address - Fax:
Practice Address - Street 1:1 HAVEN PLZ
Practice Address - Street 2:APT. 4E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3904
Practice Address - Country:US
Practice Address - Phone:212-614-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008979-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist