Provider Demographics
NPI:1801028402
Name:SKODA, REBECCA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:SKODA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CRYSTAL ST.
Mailing Address - Street 2:MMHT
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701
Mailing Address - Country:US
Mailing Address - Phone:845-790-0911
Mailing Address - Fax:845-791-7304
Practice Address - Street 1:20 CRYSTAL ST.
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701
Practice Address - Country:US
Practice Address - Phone:845-790-0911
Practice Address - Fax:845-791-7304
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0704341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical