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General NPI Number Information
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NPI Number | 1033204375
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Entity Type | Individual
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Provider Name | SCOTT PEALE MOONEY PHD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 112 E BRIDGE ST
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City | OSWEGO
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State | NY
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Zip | 13126-2259
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Country | US
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Telephone | 315-342-5941
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Fax |
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Provider Business Mailing Address
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Address Line | 3473 PORTER COTTAGE
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-9280
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Country | US
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Telephone | 315-635-2959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 012205
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License Number State | NY
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