Provider Demographics
NPI:1851961734
Name:DIETZMAN, SKYLER (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SKYLER
Middle Name:
Last Name:DIETZMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:SKYLER
Other - Middle Name:
Other - Last Name:MAKKINJE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1730
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03244-1730
Mailing Address - Country:US
Mailing Address - Phone:719-641-8860
Mailing Address - Fax:
Practice Address - Street 1:1966 MAPLE ST APT 4
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:NH
Practice Address - Zip Code:03229-3315
Practice Address - Country:US
Practice Address - Phone:719-641-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHSW184191041S0200X
FLSW184191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty