Provider Demographics
NPI:1629489331
Name:VINCENT P SKOTKO PHD
Entity Type:Organization
Organization Name:VINCENT P SKOTKO PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:813-224-0249
Mailing Address - Street 1:722 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3133
Mailing Address - Country:US
Mailing Address - Phone:813-224-0249
Mailing Address - Fax:813-228-0192
Practice Address - Street 1:722 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3133
Practice Address - Country:US
Practice Address - Phone:813-224-0249
Practice Address - Fax:813-228-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2791103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75156Medicare PIN