Healthcare Provider Details

I. General information

NPI: 1295124808
Provider Name (Legal Business Name): JEREMY S SKOW LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 BEVERLY RD
GREAT NECK NY
11021-1329
US

IV. Provider business mailing address

444 COMMUNITY DR STE 304
MANHASSET NY
11030-3820
US

V. Phone/Fax

Practice location:
  • Phone: 516-322-9133
  • Fax:
Mailing address:
  • Phone: 516-322-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006359
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: