Provider Demographics
NPI:1447257886
Name:SCOTT, KAMAKAOKALANI PENNY (LPCMH, NCC, CGC)
Entity type:Individual
Prefix:
First Name:KAMAKAOKALANI
Middle Name:PENNY
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPCMH, NCC, CGC
Other - Prefix:
Other - First Name:K.
Other - Middle Name:PENNY
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCMH, NCC, CGC
Mailing Address - Street 1:509 ROUTE 530
Mailing Address - Street 2:APT 374
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-3145
Mailing Address - Country:US
Mailing Address - Phone:732-408-7035
Mailing Address - Fax:
Practice Address - Street 1:509 ROUTE 530
Practice Address - Street 2:APT 374
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-3145
Practice Address - Country:US
Practice Address - Phone:732-408-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000032331Medicaid
DE628014OtherMAMSI PROVIDER ID NUMBER
DE70230OtherUBH PROVIDER ID NUMBER