Provider Demographics
NPI:1275684870
Name:SKIZYNSKI, LEONARD JOHN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:JOHN
Last Name:SKIZYNSKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 ADRIANE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4902
Mailing Address - Country:US
Mailing Address - Phone:407-847-8375
Mailing Address - Fax:407-847-8450
Practice Address - Street 1:21 S RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5443
Practice Address - Country:US
Practice Address - Phone:407-847-8375
Practice Address - Fax:407-847-8450
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3764103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73587OtherBCBS NUMBER
FL73587Medicare ID - Type Unspecified