Provider Demographics
NPI:1104169705
Name:SKINNER, JACQUELYN SKINNER B (MA)
Entity type:Individual
Prefix:
First Name:JACQUELYN SKINNER
Middle Name:B
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063
Mailing Address - Country:US
Mailing Address - Phone:724-452-4453
Mailing Address - Fax:
Practice Address - Street 1:1008 7TH AVE.
Practice Address - Street 2:SUITE 210
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010
Practice Address - Country:US
Practice Address - Phone:724-452-4453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health