Healthcare Provider Details

I. General information

NPI: 1780102897
Provider Name (Legal Business Name): BEATA CAROLINE SKONECKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 NIAGARA FALLS BLVD
TONAWANDA NY
14150-8431
US

IV. Provider business mailing address

55 DODGE RD
GETZVILLE NY
14068-1205
US

V. Phone/Fax

Practice location:
  • Phone: 716-833-3792
  • Fax:
Mailing address:
  • Phone: 716-831-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number096648
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: