Healthcare Provider Details

I. General information

NPI: 1649181892
Provider Name (Legal Business Name): CYNTHIA R SCOTT-DEROUX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19719 HOLLIS AVE
SAINT ALBANS NY
11412-1227
US

IV. Provider business mailing address

19719 HOLLIS AVE
SAINT ALBANS NY
11412-1227
US

V. Phone/Fax

Practice location:
  • Phone: 929-276-2349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP145367
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: