Healthcare Provider Details

I. General information

NPI: 1437521952
Provider Name (Legal Business Name): SCOTT W. WOERNER, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BROAD ST
BLOOMFIELD NJ
07003-2605
US

IV. Provider business mailing address

2687 CREST LN
SCOTCH PLAINS NJ
07076-1513
US

V. Phone/Fax

Practice location:
  • Phone: 908-377-0574
  • Fax:
Mailing address:
  • Phone: 908-377-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number35SI0054900
License Number StateNJ

VIII. Authorized Official

Name: DR. SCOTT W WOERNER
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 908-377-9574