Provider Demographics
NPI:1447522677
Name:SKULA-CHANNING, JUNE MARYANNE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:MARYANNE
Last Name:SKULA-CHANNING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:NY
Mailing Address - Zip Code:12176-2314
Mailing Address - Country:US
Mailing Address - Phone:518-966-5819
Mailing Address - Fax:518-966-5819
Practice Address - Street 1:638 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:NY
Practice Address - Zip Code:12176-2314
Practice Address - Country:US
Practice Address - Phone:518-966-5819
Practice Address - Fax:518-966-5819
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY148599021OtherSCHOOL PSYCHOLOGIST CONTROL NUMBER
NY058645-1OtherLMSW LICENSE NUMBER -