Provider Demographics
NPI:1073977229
Name:WUNDER, SCOTT (LCSW)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WUNDER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BROADWAY SUITE 200
Mailing Address - Street 2:NEWBURGH MENTAL HEALTH CLINIC
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8770
Mailing Address - Country:US
Mailing Address - Phone:845-562-7326
Mailing Address - Fax:845-565-0826
Practice Address - Street 1:280 BROADWAY STE NEWBURGH
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5408
Practice Address - Country:US
Practice Address - Phone:845-562-7326
Practice Address - Fax:845-565-0826
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY74334-11041C0700X
NY074334-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical