Provider Demographics
NPI:1659383958
Name:SKUNTA, LYNN MARIE
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:SKUNTA
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 1:4859 DOVER CENTER RD STE 9
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3191
Mailing Address - Country:US
Mailing Address - Phone:440-779-8880
Mailing Address - Fax:
Practice Address - Street 1:4859 DOVER CENTER RD STE 9
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3191
Practice Address - Country:US
Practice Address - Phone:440-779-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001242101YM0800X
OHS0009466104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker