Provider Demographics
NPI:1275602823
Name:SKINNER, L DAISY (MSW)
Entity Type:Individual
Prefix:
First Name:L
Middle Name:DAISY
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 62401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20-2562771OtherEIN
FLZ0833Medicare ID - Type Unspecified