Provider Demographics
NPI:1255468377
Name:L DAISY SKINNER MSW PA
Entity Type:Organization
Organization Name:L DAISY SKINNER MSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:DAISY
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-795-9079
Mailing Address - Street 1:12777 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 1501
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4775
Mailing Address - Country:US
Mailing Address - Phone:561-795-9079
Mailing Address - Fax:561-795-9033
Practice Address - Street 1:12777 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 1501
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4775
Practice Address - Country:US
Practice Address - Phone:561-795-9079
Practice Address - Fax:561-795-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW62401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1275602823OtherINDIVIDUAL NPI
FLZ0833Medicare ID - Type Unspecified