Healthcare Provider Details

I. General information

NPI: 1437676681
Provider Name (Legal Business Name): MEGAN VICTORIA KOWALCHICK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CANDEE AVE
SAYVILLE NY
11782-3055
US

IV. Provider business mailing address

23 CANDEE AVE
SAYVILLE NY
11782-3055
US

V. Phone/Fax

Practice location:
  • Phone: 855-552-9355
  • Fax: 855-552-9355
Mailing address:
  • Phone: 855-552-9355
  • Fax: 855-552-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number876661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: