Provider Demographics
NPI:1558857862
Name:NIEWINSKI, SCOTT ANDREW (MA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANDREW
Last Name:NIEWINSKI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 W HURON ST # 107
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1601
Mailing Address - Country:US
Mailing Address - Phone:248-724-7600
Mailing Address - Fax:248-636-4025
Practice Address - Street 1:461 W HURON ST # 107
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:248-724-7600
Practice Address - Fax:248-636-4025
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MI6301019359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor