Healthcare Provider Details

I. General information

NPI: 1528229945
Provider Name (Legal Business Name): BARRY MICHAEL SKOBLAR PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 RACINE DR STE B
WILMINGTON NC
28403-8828
US

IV. Provider business mailing address

219 RACINE DR STE B
WILMINGTON NC
28403-8828
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-6277
  • Fax: 910-791-6226
Mailing address:
  • Phone: 910-791-6277
  • Fax: 910-791-6226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3576
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: