Healthcare Provider Details

I. General information

NPI: 1942284567
Provider Name (Legal Business Name): SONDRA L SCOTT LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 NORTH AVE
PLEASANT VALLEY NY
12569-6063
US

IV. Provider business mailing address

PO BOX 43
WAPPINGERS FALLS NY
12590-0043
US

V. Phone/Fax

Practice location:
  • Phone: 845-505-9975
  • Fax: 888-972-5017
Mailing address:
  • Phone: 845-849-1958
  • Fax: 888-972-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR058225-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: