Healthcare Provider Details

I. General information

NPI: 1497680623
Provider Name (Legal Business Name): DAVID GUSTAV SCHOLZ LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 EDGERLY ST
BERLIN CT
06037-2115
US

IV. Provider business mailing address

32 EDGERLY ST
BERLIN CT
06037-2115
US

V. Phone/Fax

Practice location:
  • Phone: 302-593-6261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9891
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: