Provider Demographics
NPI:1740430065
Name:SKRODZKI, MICHAEL (MA, MFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:SKRODZKI
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:WOODACRE
Mailing Address - State:CA
Mailing Address - Zip Code:94973-0922
Mailing Address - Country:US
Mailing Address - Phone:415-488-9836
Mailing Address - Fax:
Practice Address - Street 1:1634 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1809
Practice Address - Country:US
Practice Address - Phone:415-488-9836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30227106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist