MEDICARE: DR. REBECCA BROMBERG SKOLNICK PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	021210	NY

General Provider Information

NPI Number	:	1356806301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA BROMBERG SKOLNICK PHD

Provider Business Mailing Address
First Line	:	80 8TH AVE STE 711
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-7176
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 8TH AVE STE 711
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-7176
Country	:	US
Telephone Number	:	646-809-5440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2019
Last Update Date	:	02/04/2019

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