Provider Demographics
NPI:1891555652
Name:SKILLINGS, BENJAMIN WILLARD
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:WILLARD
Last Name:SKILLINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RIVERSIDE ST UNIT A6
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1068
Mailing Address - Country:US
Mailing Address - Phone:207-749-9070
Mailing Address - Fax:
Practice Address - Street 1:96 ROUTE 133
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-1354
Practice Address - Country:US
Practice Address - Phone:207-749-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)