Healthcare Provider Details

I. General information

NPI: 1992329676
Provider Name (Legal Business Name): ANN KOWALSKI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 OLD SANDWICH RD
PLYMOUTH MA
02360-2516
US

IV. Provider business mailing address

1259 OLD SANDWICH RD
PLYMOUTH MA
02360-2516
US

V. Phone/Fax

Practice location:
  • Phone: 508-517-0679
  • Fax:
Mailing address:
  • Phone: 508-517-0679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11836
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: