Provider Demographics
NPI:1366637738
Name:SKINNER, ELEANOR MARY (EDD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:MARY
Last Name:SKINNER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-3438
Mailing Address - Country:US
Mailing Address - Phone:413-256-1448
Mailing Address - Fax:
Practice Address - Street 1:664 MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2439
Practice Address - Country:US
Practice Address - Phone:413-253-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3979103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO3970OtherBLUECROSSBLUESHIELD