Healthcare Provider Details

I. General information

NPI: 1598891442
Provider Name (Legal Business Name): MARK EDWARD NOWAKOWSKI LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CAMBRIDGE AVE.
MORRISVILLE NY
13408
US

IV. Provider business mailing address

165 MAIN ST STE A
CORTLAND NY
13045-3049
US

V. Phone/Fax

Practice location:
  • Phone: 315-684-1172
  • Fax: 315-684-1200
Mailing address:
  • Phone: 607-753-0234
  • Fax: 607-753-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078112
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: