Healthcare Provider Details

I. General information

NPI: 1477765055
Provider Name (Legal Business Name): DENNIS CHRISTOPHER SKOW LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 ROANOKE AVE
RIVERHEAD NY
11901-2098
US

IV. Provider business mailing address

65 ISLAND BLVD APT H
BOHEMIA NY
11716-4934
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-0022
  • Fax:
Mailing address:
  • Phone: 631-750-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number068662-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: