Provider Demographics
NPI:1356362636
Name:SKOLNIK, JOSEPH C (LICSW)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:C
Last Name:SKOLNIK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BRAY ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1554
Mailing Address - Country:US
Mailing Address - Phone:978-281-8445
Mailing Address - Fax:
Practice Address - Street 1:9 MERIAM ST
Practice Address - Street 2:STE 18
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-5300
Practice Address - Country:US
Practice Address - Phone:781-863-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1034051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22740Medicare ID - Type Unspecified
MAP01647Medicare ID - Type Unspecified