Provider Demographics
NPI:1265506604
Name:RUDOLPH SKOWRONSKI LCSW LLC
Entity Type:Organization
Organization Name:RUDOLPH SKOWRONSKI LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:SKOWRONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-571-3008
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-0551
Mailing Address - Country:US
Mailing Address - Phone:207-571-3008
Mailing Address - Fax:207-571-3263
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:SUITE 1306
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3509
Practice Address - Country:US
Practice Address - Phone:207-571-3008
Practice Address - Fax:207-571-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC67291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0224Medicare PIN