Provider Demographics
NPI:1366796443
Name:ENTRIKIN, SCOTT G (LAC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:G
Last Name:ENTRIKIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GAJEWSKI LN
Mailing Address - Street 2:
Mailing Address - City:WEST CREEK
Mailing Address - State:NJ
Mailing Address - Zip Code:08092-9668
Mailing Address - Country:US
Mailing Address - Phone:609-713-7731
Mailing Address - Fax:
Practice Address - Street 1:1466 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2892
Practice Address - Country:US
Practice Address - Phone:732-383-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00113900101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor