Diane M Scoville, PHD, LICSW

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY00003677 Issued in WA

Practice address

4026 NE 55TH St Ste C
Seattle, WA 98105-2254

Phone

(206) 227-1220

NPI assigned

Jun 25, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 9, 2021 through Feb 9, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1306042643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4026 NE 55TH ST STE C",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981052254",
            "telephone_number": "206-227-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4026 NE 55TH ST STE C",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981052254",
            "telephone_number": "206-227-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOVILLE",
        "first_name": "DIANE",
        "middle_name": "M",
        "credential": "PHD, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-25",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00003677",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW00005608",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Scott, MD
• William Paul Scott Jr., LICSW
• Zachary Scott
• Lauren Gabrielle Scovel, MD
• Judson Lawrence Scovill, LICSW, CDP, CCDC-I,
• SCR PS
• Scrips Incorporated
• Monica Faye Scruggs, ANP
• Shannon Marie Scruggs
• SCS of Seattle, a Professional Corporation

• Clinical Psychologist in Seattle, WA
• Providers in Seattle, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.