Provider Demographics
NPI:1902660798
Name:WISEMAN, SCOTT (MS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WISEMAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 LAKE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8376
Mailing Address - Country:US
Mailing Address - Phone:679-309-6202
Mailing Address - Fax:
Practice Address - Street 1:1825 JESS PARRISH CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2104
Practice Address - Country:US
Practice Address - Phone:321-567-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)