Provider Demographics
NPI:1386680858
Name:SKOWRONSKI, RUDOLPH ALBERT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:ALBERT
Last Name:SKOWRONSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 BACK RD
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-3289
Mailing Address - Country:US
Mailing Address - Phone:077-768-2452
Mailing Address - Fax:207-571-3263
Practice Address - Street 1:199 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1508
Practice Address - Country:US
Practice Address - Phone:207-776-8245
Practice Address - Fax:207-571-3263
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC67291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2120621OtherCIGNA PROVIDER NUMBER
ME7173577000OtherMAGELLAN PROVIDER NUMBER
MEME0224Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER