Basic Information
| Provider Information | |||||||||
| NPI: | 1891100327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOERNER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | |||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2687 CREST LN | ||||||||
| Address2: | |||||||||
| City: | SCOTCH PLAINS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070761513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083779574 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
| FaxNumber: | 9087906576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2014 | ||||||||
| LastUpdateDate: | 11/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 35SI00540900 | NJ | Y | Behavioral Health & Social Service Providers | Psychologist | 101YP2500X | 37PC00430400 | NJ | N | Behavioral Health & Social Service Providers | Counselor | Professional | 103T00000X | 020652 | NY | N | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.