Healthcare Provider Details

I. General information

NPI: 1891100327
Provider Name (Legal Business Name): SCOTT WOERNER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DIAMOND HILL RD
BERKELEY HEIGHTS NJ
07922-2104
US

IV. Provider business mailing address

2687 CREST LN
SCOTCH PLAINS NJ
07076-1513
US

V. Phone/Fax

Practice location:
  • Phone: 908-273-4300
  • Fax: 908-790-6576
Mailing address:
  • Phone: 908-377-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00540900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00430400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number020652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: