Healthcare Provider Details

I. General information

NPI: 1033586581
Provider Name (Legal Business Name): MICHAEL DAVID SKIBBA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S ARROYO PKWY STE 420
PASADENA CA
91105-3215
US

IV. Provider business mailing address

675 S ARROYO PKWY STE 420
PASADENA CA
91105-3215
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone: 925-282-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW77721
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number97783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: