Provider Demographics
NPI:1407453566
Name:ALTIMARI, SKYLAR ELLE
Entity Type:Individual
Prefix:
First Name:SKYLAR
Middle Name:ELLE
Last Name:ALTIMARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SEWARD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7907
Mailing Address - Country:US
Mailing Address - Phone:631-896-1731
Mailing Address - Fax:
Practice Address - Street 1:13325 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2941
Practice Address - Country:US
Practice Address - Phone:929-277-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health