Healthcare Provider Details

I. General information

NPI: 1760781108
Provider Name (Legal Business Name): NORMA M KOWALSKI PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 GRIFFIN RD
DAVIE FL
33314-4341
US

IV. Provider business mailing address

6816 GRIFFIN RD
DAVIE FL
33314-4341
US

V. Phone/Fax

Practice location:
  • Phone: 954-586-0624
  • Fax: 954-580-0430
Mailing address:
  • Phone: 954-586-0624
  • Fax: 954-580-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY8258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: