Provider Demographics
NPI:1871730390
Name:ADAMS, SCOTT JERAULD (PSYD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JERAULD
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CONSTITUTION DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6076
Mailing Address - Country:US
Mailing Address - Phone:303-898-9347
Mailing Address - Fax:
Practice Address - Street 1:18 CONSTITUTION DR STE 1
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6076
Practice Address - Country:US
Practice Address - Phone:303-898-9347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2872103TC0700X
NH00015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01003583OtherRAILROAD MEDICARE
CO00983021Medicaid
CO2872OtherSTATE LICENSE
NH00015OtherSTATE LICENSE