Healthcare Provider Details

I. General information

NPI: 1669240008
Provider Name (Legal Business Name): DANA M SKOLNICK WIZEMAN LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANA WIZEMAN LGPC

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 LAVENDER CT
WEST RIVER MD
20778-2114
US

IV. Provider business mailing address

605 LAVENDER CT
WEST RIVER MD
20778-2114
US

V. Phone/Fax

Practice location:
  • Phone: 718-344-3217
  • Fax:
Mailing address:
  • Phone: 718-344-3217
  • 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: