Provider Demographics
NPI:1033204375
Name:MOONEY, SCOTT PEALE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PEALE
Last Name:MOONEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3473 PORTER COTTAGE
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9280
Mailing Address - Country:US
Mailing Address - Phone:315-635-2959
Mailing Address - Fax:
Practice Address - Street 1:112 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2259
Practice Address - Country:US
Practice Address - Phone:315-342-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical