Provider Demographics
NPI:1669710182
Name:DALTON, SCOTT J
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:J
Last Name:DALTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-5127
Mailing Address - Country:US
Mailing Address - Phone:321-799-0449
Mailing Address - Fax:
Practice Address - Street 1:300 COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-5127
Practice Address - Country:US
Practice Address - Phone:321-799-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor