Healthcare Provider Details

I. General information

NPI: 1801028402
Provider Name (Legal Business Name): REBECCA ANN SKODA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CRYSTAL ST.
MONTICELLO NY
12701
US

IV. Provider business mailing address

20 CRYSTAL ST. MMHT
MONTICELLO NY
12701
US

V. Phone/Fax

Practice location:
  • Phone: 845-790-0911
  • Fax: 845-791-7304
Mailing address:
  • Phone: 845-790-0911
  • Fax: 845-791-7304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070434
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: