Provider Demographics
NPI:1720346000
Name:SKOP, DAWN M (LMHC, LADC1)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:SKOP
Suffix:
Gender:F
Credentials:LMHC, LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1219
Mailing Address - Country:US
Mailing Address - Phone:508-944-5449
Mailing Address - Fax:
Practice Address - Street 1:175 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1219
Practice Address - Country:US
Practice Address - Phone:508-944-5449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4774101Y00000X, 101YM0800X
MA1414101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)