Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | MC12254 | ME |
NPI | 1003138280 |
---|---|
Provider Name | Mr. Gregory J Skillman |
First Address | Hallowell, ME 04347-0128 |
Second Address | Augusta, ME 04330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2010 |
Last Update Date | 16/02/2010 |