Healthcare Provider Details

I. General information

NPI: 1790946044
Provider Name (Legal Business Name): DAVID BRENDAN SKOWRONSKI LPC, M.A., NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH ST SUITE 1307
PHILADELPHIA PA
19103-6213
US

IV. Provider business mailing address

255 S 17TH ST SUITE 1307
PHILADELPHIA PA
19103-6213
US

V. Phone/Fax

Practice location:
  • Phone: 215-282-3004
  • Fax:
Mailing address:
  • Phone: 215-282-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC003354
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: