Basic Information
Provider Information | |||||||||
NPI: | 1508878810 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SKOLER | ||||||||
FirstName: | SHIRLEY | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW LICSW LCSWC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WEISS | ||||||||
OtherFirstName: | SHIRLEY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 6123 MONTROSE RD | ||||||||
Address2: |   | ||||||||
City: | ROCKVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 20852 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3018813700 | ||||||||
FaxNumber: | 3014681862 | ||||||||
Practice Location | |||||||||
Address1: | 3018 JAVIER RD | ||||||||
Address2: |   | ||||||||
City: | FAIRFAX | ||||||||
State: | VA | ||||||||
PostalCode: | 22031 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7032049100 | ||||||||
FaxNumber: | 7032049590 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/13/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 00274 | MD | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 104100000X | LC301131 | DC | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 104100000X |   | VA | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
ID Information
ID | Type | State | Issuer | Description | A2840021 | 01 | DC | BCBS OF DC | OTHER | 5395607 | 01 | VA | AETNA | OTHER | 54074 | 01 | VA | UBH | OTHER | 230794 | 01 | VA | KAISER | OTHER |