Provider Demographics
NPI:1962516146
Name:SKLODOWSKI, STEPHANIE J (LPCMH)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:J
Last Name:SKLODOWSKI
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E DELAWARE AVENUE
Mailing Address - Street 2:NEWARK HIGH SCHOOL
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 E DELAWARE AVENUE
Practice Address - Street 2:NEWARK HIGH SCHOOL
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7185
Practice Address - Country:US
Practice Address - Phone:302-369-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-000312101YM0800X
DEPC-0000312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEDON'T HAVEMedicaid
DE5103872OtherBLUE CROSS BLUE SHIELD