Provider Demographics
NPI:1629091707
Name:SKOLNIK, BENJAMIN D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:D
Last Name:SKOLNIK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 DORSET ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6209
Mailing Address - Country:US
Mailing Address - Phone:802-654-7607
Mailing Address - Fax:802-654-9155
Practice Address - Street 1:366 DORSET ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6209
Practice Address - Country:US
Practice Address - Phone:802-654-7607
Practice Address - Fax:802-654-9155
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000724103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical