Provider Demographics
NPI:1629194808
Name:SKOLODA, THOMAS E (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:SKOLODA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:775 NORTH SHORE DRIVE
Mailing Address - City:ANNA MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34216-0872
Mailing Address - Country:US
Mailing Address - Phone:941-778-4184
Mailing Address - Fax:
Practice Address - Street 1:5000 LAKEWOOD RANCH BLVD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4909
Practice Address - Country:US
Practice Address - Phone:941-756-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6654103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist