Healthcare Provider Details

I. General information

NPI: 1649053315
Provider Name (Legal Business Name): JUDITH SKOLNICK LCSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 HEADWATERS DR
HARWICH MA
02645-1035
US

IV. Provider business mailing address

92 HEADWATERS DR
HARWICH MA
02645-1035
US

V. Phone/Fax

Practice location:
  • Phone: 646-256-1709
  • Fax:
Mailing address:
  • Phone: 646-256-1709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number223318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: