Provider Demographics
NPI:1083194617
Name:FULL, SKYLER (LCSW)
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:
Last Name:FULL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6737
Mailing Address - Country:US
Mailing Address - Phone:585-506-2087
Mailing Address - Fax:844-205-8447
Practice Address - Street 1:5500 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6737
Practice Address - Country:US
Practice Address - Phone:585-506-2087
Practice Address - Fax:844-205-8447
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker