Healthcare Provider Details

I. General information

NPI: 1003133810
Provider Name (Legal Business Name): PATRICK CHARLES KOWALSKI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 9TH ST
SAN FRANCISCO CA
94103-2603
US

IV. Provider business mailing address

170 9TH ST
SAN FRANCISCO CA
94103-2603
US

V. Phone/Fax

Practice location:
  • Phone: 415-777-0333
  • Fax: 415-869-4042
Mailing address:
  • Phone: 415-777-0333
  • Fax: 415-869-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-07166
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: