Basic Information
| Provider Information | |||||||||
| NPI: | 1689814485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OTEY-SCOTT | ||||||||
| FirstName: | STACIE | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | PSY.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573976344 | ||||||||
| FaxNumber: | 7576061185 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 CRAWFORD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237043820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573976344 | ||||||||
| FaxNumber: | 7576061185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2009 | ||||||||
| LastUpdateDate: | 07/31/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0810004079 | VA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 368853 | 01 | VA | ANTHEM BEHAVIORAL HEALTH (GHENT FAMILY MEDICINE | OTHER | PAR | 01 | VA | VA PREMIER HEALTH | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | AETNA | OTHER | 2731640 | 01 | VA | CIGNA BEHAVIORAL HEALTH | OTHER | 440878 | 01 | VA | MANAGED HEALTH NETWORK/TRICARE | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | MIS 600566-849 | 01 | VA | MAGELLAN HEALTH SERVICES | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | OPTIMA BEHAVIORAL HEALTH | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERICAL | OTHER | 1689814485 | 05 | VA | MEDICAID | 368851 | 01 | VA | ANTHEM BEHAVIORAL HEALTH (PORTSMOUTH FAMILY MEDICINE) | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER |