Healthcare Provider Details

I. General information

NPI: 1174361646
Provider Name (Legal Business Name): BRAJAN KAJETAN KOWALSKI RCSWI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 08/03/2024
Certification Date: 08/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4837 SWIFT RD STE 110-9
SARASOTA FL
34231-5182
US

IV. Provider business mailing address

2539 RIVER PRESERVE CT
BRADENTON FL
34208-7464
US

V. Phone/Fax

Practice location:
  • Phone: 614-500-3889
  • Fax:
Mailing address:
  • Phone: 941-363-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW20560
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: