Provider Demographics
NPI:1134835044
Name:SKOWRONSKI, CARLY MICHELE (BCBA)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:MICHELE
Last Name:SKOWRONSKI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 HERON LN
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-8578
Mailing Address - Country:US
Mailing Address - Phone:815-260-8355
Mailing Address - Fax:
Practice Address - Street 1:18370 LIMESTONE CREEK RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3860
Practice Address - Country:US
Practice Address - Phone:561-598-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-22-58702103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty