Healthcare Provider Details

I. General information

NPI: 1225157019
Provider Name (Legal Business Name): AGATA ELIZABETH NOWAKOWSKA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 ACADEMY DR
SOLANA BEACH CA
92075-2031
US

IV. Provider business mailing address

2154 RANCH VIEW TER
ENCINITAS CA
92024-6534
US

V. Phone/Fax

Practice location:
  • Phone: 760-484-1853
  • Fax: 858-793-4406
Mailing address:
  • Phone: 760-484-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: