Provider Demographics
NPI:1356645568
Name:SCKUPAKUS, MEGAN (CT-AD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SCKUPAKUS
Suffix:
Gender:F
Credentials:CT-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5044
Mailing Address - Country:US
Mailing Address - Phone:410-860-9600
Mailing Address - Fax:410-860-8511
Practice Address - Street 1:220 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5044
Practice Address - Country:US
Practice Address - Phone:410-860-9600
Practice Address - Fax:410-860-8511
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility