Healthcare Provider Details

I. General information

NPI: 1558857862
Provider Name (Legal Business Name): SCOTT ANDREW NIEWINSKI MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 W HURON ST # 107
PONTIAC MI
48341-1601
US

IV. Provider business mailing address

461 W HURON ST # 107
PONTIAC MI
48341-1601
US

V. Phone/Fax

Practice location:
  • Phone: 248-724-7600
  • Fax: 248-636-4025
Mailing address:
  • Phone: 248-724-7600
  • Fax: 248-636-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019359
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: