Basic Information
Provider Information
NPI: 1972797280
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SKOWRONSKI
FirstName: DAWN
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: LCSWR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1526 WALDEN AVE
Address2: SUITE 400
City: CHEEKTOWAGA
State: NY
PostalCode: 142254985
CountryCode: US
TelephoneNumber: 7168957167
FaxNumber: 7168960318
Practice Location
Address1: 1526 WALDEN AVE
Address2: SUITE 400
City: CHEEKTOWAGA
State: NY
PostalCode: 142254985
CountryCode: US
TelephoneNumber: 7168957167
FaxNumber: 7168960318
Other Information
ProviderEnumerationDate: 08/29/2007
LastUpdateDate: 12/23/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XR032404-1NYY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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