Provider Demographics
NPI:1174968044
Name:SCOTT, SUSAN DIANE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
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 1:3628 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5069
Mailing Address - Country:US
Mailing Address - Phone:916-840-1059
Mailing Address - Fax:916-388-3232
Practice Address - Street 1:3628 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5069
Practice Address - Country:US
Practice Address - Phone:916-388-3231
Practice Address - Fax:916-388-3232
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW125443101Y00000X, 1041C0700X
101YM0800X, 1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health