Healthcare Provider Details

I. General information

NPI: 1538658067
Provider Name (Legal Business Name): TONYA A SKOVORODINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 APPLETON ST STE 5
HOLYOKE MA
01040-3236
US

IV. Provider business mailing address

36 ADAMS ST
AGAWAM MA
01001-3402
US

V. Phone/Fax

Practice location:
  • Phone: 978-799-7397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: