Healthcare Provider Details

I. General information

NPI: 1780254250
Provider Name (Legal Business Name): ANDREW KOWAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 PLAINFIELD PIKE
CRANSTON RI
02921-2031
US

IV. Provider business mailing address

350 FORT ST
EAST PROVIDENCE RI
02914-4956
US

V. Phone/Fax

Practice location:
  • Phone: 401-889-3780
  • Fax: 401-223-6506
Mailing address:
  • Phone: 401-225-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: