Healthcare Provider Details

I. General information

NPI: 1386680858
Provider Name (Legal Business Name): RUDOLPH ALBERT SKOWRONSKI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 MAIN ST FL 3
SACO ME
04072-1508
US

IV. Provider business mailing address

276 BACK RD
ALFRED ME
04002-3289
US

V. Phone/Fax

Practice location:
  • Phone: 207-776-8245
  • Fax: 207-571-3263
Mailing address:
  • Phone: 77-768-2452
  • Fax: 207-571-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC6729
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: