Healthcare Provider Details

I. General information

NPI: 1235776337
Provider Name (Legal Business Name): SCOTT M WUSHENSKY MS, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2019
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 BROOKSIDE AVE
SWARTHMORE PA
19081-2620
US

IV. Provider business mailing address

721 BROOKSIDE AVE
SWARTHMORE PA
19081-2620
US

V. Phone/Fax

Practice location:
  • Phone: 610-764-3970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC015483
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: