Healthcare Provider Details

I. General information

NPI: 1073977229
Provider Name (Legal Business Name): SCOTT WUNDER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 BROADWAY STE NEWBURGH
NEWBURGH NY
12550-5408
US

IV. Provider business mailing address

280 BROADWAY SUITE 200 NEWBURGH MENTAL HEALTH CLINIC
NEWBURGH NY
12550-8770
US

V. Phone/Fax

Practice location:
  • Phone: 845-562-7326
  • Fax: 845-565-0826
Mailing address:
  • Phone: 845-562-7326
  • Fax: 845-565-0826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number74334-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074334-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: