Healthcare Provider Details

I. General information

NPI: 1407164908
Provider Name (Legal Business Name): SARA ELIZABETH SKONIECZNY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WALNUT ST STE 300
WELLESLEY MA
02481-2145
US

IV. Provider business mailing address

83 BARSTOW ST
SALEM MA
01970-2303
US

V. Phone/Fax

Practice location:
  • Phone: 617-286-5002
  • Fax:
Mailing address:
  • Phone: 508-331-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118093
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: