Healthcare Provider Details

I. General information

NPI: 1497969984
Provider Name (Legal Business Name): MICHAEL PAUL KOWITT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CYNWYD RD
BALA CYNWYD PA
19004-3306
US

IV. Provider business mailing address

3 CYNWYD RD
BALA CYNWYD PA
19004-3306
US

V. Phone/Fax

Practice location:
  • Phone: 610-660-9791
  • Fax:
Mailing address:
  • Phone: 610-660-9791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS2865-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: