Provider Demographics
NPI:1174962013
Name:SKOWYSZ, BENJAMIN E (LCSW, CSOTP)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:E
Last Name:SKOWYSZ
Suffix:
Gender:M
Credentials:LCSW, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12232 GAYTON STATION BLVD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6623
Mailing Address - Country:US
Mailing Address - Phone:804-360-3988
Mailing Address - Fax:
Practice Address - Street 1:12232 GAYTON STATION BLVD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-6623
Practice Address - Country:US
Practice Address - Phone:804-360-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812000474103T00000X
VA09040057271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist