Provider Demographics
NPI:1538401674
Name:SKOWRON, JEFFREY JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
Last Name:SKOWRON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3909
Mailing Address - Country:US
Mailing Address - Phone:508-365-5163
Mailing Address - Fax:
Practice Address - Street 1:330 GROVE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3909
Practice Address - Country:US
Practice Address - Phone:508-365-5163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-7947103K00000X
MA8556103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst