Provider Demographics
NPI:1205576303
Name:SKG WELLNESS, LLC
Entity type:Organization
Organization Name:SKG WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KILDUFF
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-740-0520
Mailing Address - Street 1:435 SHIRLEY ST APT 1-4
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1260
Mailing Address - Country:US
Mailing Address - Phone:508-740-0520
Mailing Address - Fax:
Practice Address - Street 1:169 RAWSON RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4404
Practice Address - Country:US
Practice Address - Phone:508-740-0520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)