Healthcare Provider Details

I. General information

NPI: 1609141688
Provider Name (Legal Business Name): SCOTT NEWKIRK PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LAUREL AVE SUITE 290
CORNWALL NY
12518-1469
US

IV. Provider business mailing address

21 LAUREL AVE SUITE 290
CORNWALL NY
12518-1469
US

V. Phone/Fax

Practice location:
  • Phone: 845-458-4558
  • Fax: 845-458-4559
Mailing address:
  • Phone: 845-458-4558
  • Fax: 845-458-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number016021
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number016021
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number016021
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number016021
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number016021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: