Provider Demographics
NPI:1023232568
Name:SCOTT, SHERYN T (PHD)
Entity type:Individual
Prefix:DR
First Name:SHERYN
Middle Name:T
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHERYN
Other - Middle Name:T
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:601 WAPELLO ST
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-1613
Mailing Address - Country:US
Mailing Address - Phone:626-797-6010
Mailing Address - Fax:626-798-7679
Practice Address - Street 1:601 WAPELLO ST
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-1613
Practice Address - Country:US
Practice Address - Phone:626-797-6010
Practice Address - Fax:626-798-7679
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023232568OtherNPI
CAPSY15365Medicare UPIN