Healthcare Provider Details

I. General information

NPI: 1245850130
Provider Name (Legal Business Name): BENJAMIN SKLARSKI LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 08/09/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 WASHINGTON HWY
MORRISVILLE VT
05661-8652
US

IV. Provider business mailing address

PO BOX 749
MORRISVILLE VT
05661-0749
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-8320
  • Fax: 802-888-8136
Mailing address:
  • Phone: 802-851-8619
  • Fax: 802-851-8716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0134227
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number068.0134227
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: