Healthcare Provider Details

I. General information

NPI: 1962860635
Provider Name (Legal Business Name): SKOTZKO-MINDCARE SOLUTIONS OF NEW JERSEY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 DUKE DR SUITE 210
FRANKLIN TN
37067-2706
US

IV. Provider business mailing address

405 DUKE DR SUITE 210
FRANKLIN TN
37067-2706
US

V. Phone/Fax

Practice location:
  • Phone: 844-291-4535
  • Fax:
Mailing address:
  • Phone: 844-291-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: WANDA THOMPSON
Title or Position: CLINICAL OP LICENSING CREDENTIALING
Credential:
Phone: 844-291-4535