Provider Demographics
NPI:1093140329
Name:KOVACIK, PHILIP ALEXANDER (LCSW, PPSC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ALEXANDER
Last Name:KOVACIK
Suffix:
Gender:M
Credentials:LCSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 SALVIO ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2599
Mailing Address - Country:US
Mailing Address - Phone:925-687-0363
Mailing Address - Fax:
Practice Address - Street 1:2730 SALVIO ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2599
Practice Address - Country:US
Practice Address - Phone:925-687-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA624881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical