Provider Demographics
NPI:1649532946
Name:SKUDRZYK, BOGUSIA (PHD)
Entity type:Individual
Prefix:DR
First Name:BOGUSIA
Middle Name:
Last Name:SKUDRZYK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 POST RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5730
Mailing Address - Country:US
Mailing Address - Phone:203-254-3242
Mailing Address - Fax:203-254-3664
Practice Address - Street 1:2000 POST RD
Practice Address - Street 2:SUITE 305
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5730
Practice Address - Country:US
Practice Address - Phone:203-254-3242
Practice Address - Fax:203-254-3664
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001987101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor