Provider Demographics
NPI:1619536026
Name:SKOMINA, CASANDRA (LMHC)
Entity Type:Individual
Prefix:
First Name:CASANDRA
Middle Name:
Last Name:SKOMINA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CASANDRA
Other - Middle Name:
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1492 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2319
Mailing Address - Country:US
Mailing Address - Phone:347-503-8625
Mailing Address - Fax:
Practice Address - Street 1:1492 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2319
Practice Address - Country:US
Practice Address - Phone:347-503-8625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health