Provider Demographics
NPI:1407164908
Name:SKONIECZNY, SARA ELIZABETH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:ELIZABETH
Last Name:SKONIECZNY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2819
Mailing Address - Country:US
Mailing Address - Phone:508-331-0577
Mailing Address - Fax:
Practice Address - Street 1:5 UPLAND RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2717
Practice Address - Country:US
Practice Address - Phone:617-684-5359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1180931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical