Provider Demographics
NPI:1285049106
Name:SKEFFINGTON, RICHARD MARK (MED, CAGS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARK
Last Name:SKEFFINGTON
Suffix:
Gender:M
Credentials:MED, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 GRANITE ST STE 108
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5367
Mailing Address - Country:US
Mailing Address - Phone:781-817-5844
Mailing Address - Fax:781-817-5724
Practice Address - Street 1:639 GRANITE ST STE 108
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5367
Practice Address - Country:US
Practice Address - Phone:781-817-5844
Practice Address - Fax:781-817-5724
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALEP # 607103TS0200X
MADESE 251074103TS0200X
DCNCSP # 22370103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool