Provider Demographics
NPI:1427670462
Name:SKURKA, CHERI
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:SKURKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-3310
Mailing Address - Country:US
Mailing Address - Phone:401-457-6501
Mailing Address - Fax:
Practice Address - Street 1:301 E GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-3310
Practice Address - Country:US
Practice Address - Phone:401-457-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherWORK RELATED