Provider Demographics
NPI:1730605304
Name:SCOTT, ALYSSA (LCSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:210 WARD STREET
Mailing Address - Street 2:219
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-6756
Mailing Address - Country:US
Mailing Address - Phone:845-235-1249
Mailing Address - Fax:
Practice Address - Street 1:210 WARD AVE STE 219
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4003
Practice Address - Country:US
Practice Address - Phone:808-585-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0854451041C0700X
HI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical