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General NPI Number Information
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NPI Number | 1588896179
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Entity Type | Organization
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Legal Business Name | PHOENIX GROUP
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 08/14/2009
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Provider Practice Location Address
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Address Line | 24 DAVIS AVE
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-2408
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Country | US
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Telephone | 845-240-3972
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Fax |
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Provider Business Mailing Address
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Address Line | 69 NORTH AVE
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City | PLEASANT VALLEY
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State | NY
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Zip | 12569-6063
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Country | US
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Telephone | 845-635-4209
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SANDRA L SCOTT
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Credential | LCSW
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Telephone | 845-635-4209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 058225
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License Number State | NY
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