Provider Demographics
NPI:1780779264
Name:SKILLINGS, TERRIE ROSE ANN (LICSW)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:ROSE ANN
Last Name:SKILLINGS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SURREY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-2258
Mailing Address - Country:US
Mailing Address - Phone:978-486-4270
Mailing Address - Fax:978-486-8087
Practice Address - Street 1:486 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3011
Practice Address - Country:US
Practice Address - Phone:978-630-3225
Practice Address - Fax:978-630-3226
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110614-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23807Medicare ID - Type UnspecifiedPROVIDER ID