Healthcare Provider Details

I. General information

NPI: 1962569020
Provider Name (Legal Business Name): PAUL JULIUS KOWATCH M.S.W., M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ALLEGHENY CTR STE 205
PITTSBURGH PA
15212-5234
US

IV. Provider business mailing address

4 ALLEGHENY CTR STE 205
PITTSBURGH PA
15212-5234
US

V. Phone/Fax

Practice location:
  • Phone: 412-559-5069
  • Fax: 412-774-2334
Mailing address:
  • Phone: 412-559-5069
  • Fax: 412-774-2334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012691
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: