Provider Demographics
NPI:1104208206
Name:NOWAK, ELI (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ELI
Middle Name:
Last Name:NOWAK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 QUACKENBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1417
Mailing Address - Country:US
Mailing Address - Phone:201-704-7637
Mailing Address - Fax:
Practice Address - Street 1:323 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1534
Practice Address - Country:US
Practice Address - Phone:201-444-3533
Practice Address - Fax:201-652-9748
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055746001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical