Provider Demographics
NPI:1023237047
Name:SCOTT, DEBORAH
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3705
Mailing Address - Country:US
Mailing Address - Phone:909-648-5385
Mailing Address - Fax:
Practice Address - Street 1:1505 W HIGHLAND AVE STE 17
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1215
Practice Address - Country:US
Practice Address - Phone:909-880-9130
Practice Address - Fax:909-473-1918
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health