Provider Demographics
NPI:1205559457
Name:SKOTNISKI, BRITTNEY ANN MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:ANN MARIE
Last Name:SKOTNISKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BRITTNEY
Other - Middle Name:ANN MARIE
Other - Last Name:IRVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:595 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1381
Mailing Address - Country:US
Mailing Address - Phone:315-629-4441
Mailing Address - Fax:
Practice Address - Street 1:24180 COUNTY ROUTE 16
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-3127
Practice Address - Country:US
Practice Address - Phone:315-629-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117614-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker