Healthcare Provider Details

I. General information

NPI: 1275761108
Provider Name (Legal Business Name): CYNTHIA SKOCYPEC BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N TRACY BLVD APT 113
TRACY CA
95376-7786
US

IV. Provider business mailing address

2800 N TRACY BLVD APT 113
TRACY CA
95376-7786
US

V. Phone/Fax

Practice location:
  • Phone: 818-203-4593
  • Fax: 267-629-8334
Mailing address:
  • Phone: 818-203-4593
  • Fax: 267-629-8334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-5648
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: