Healthcare Provider Details

I. General information

NPI: 1184276354
Provider Name (Legal Business Name): ELLIOTT DALTON SKAGGS LMHC-D, LCMHC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 LEXINGTON AVE FRNT 2 #1044
NEW YORK NY
10028
US

IV. Provider business mailing address

1280 LEXINGTON AVE FRNT 2 #1044
NEW YORK NY
10028
US

V. Phone/Fax

Practice location:
  • Phone: 917-960-2153
  • Fax:
Mailing address:
  • Phone: 917-960-2153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number015352
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: