Healthcare Provider Details

I. General information

NPI: 1356362636
Provider Name (Legal Business Name): JOSEPH C SKOLNIK LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MERIAM ST STE 18
LEXINGTON MA
02420-5300
US

IV. Provider business mailing address

108 BRAY ST
GLOUCESTER MA
01930-1554
US

V. Phone/Fax

Practice location:
  • Phone: 781-863-1966
  • Fax:
Mailing address:
  • Phone: 978-281-8445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103405
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: