Healthcare Provider Details

I. General information

NPI: 1124403241
Provider Name (Legal Business Name): JANICE KOWALSKI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 VICTORY BLVD
STATEN ISLAND NY
10314-3547
US

IV. Provider business mailing address

1688 VICTORY BLVD
STATEN ISLAND NY
10314-3547
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-5700
  • Fax:
Mailing address:
  • Phone: 718-447-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number092763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: