Healthcare Provider Details

I. General information

NPI: 1568737419
Provider Name (Legal Business Name): MARVIN SKORMAN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2012
Last Update Date: 03/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 CLINTON AVE S SUITE 445
ROCHESTER NY
14618-5720
US

IV. Provider business mailing address

1815 CLINTON AVE S SUITE 445
ROCHESTER NY
14618-5720
US

V. Phone/Fax

Practice location:
  • Phone: 585-256-3860
  • Fax: 585-256-0660
Mailing address:
  • Phone: 585-256-3860
  • Fax: 585-256-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number003478 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: