Provider Demographics
NPI:1164535514
Name:MAKAROWSKI, LOUIS M (PHD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:M
Last Name:MAKAROWSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:LOU
Other - Middle Name:M
Other - Last Name:MAKAROWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5120 BAYOU BLVD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2193
Mailing Address - Country:US
Mailing Address - Phone:850-477-7181
Mailing Address - Fax:850-477-7197
Practice Address - Street 1:5120 BAYOU BLVD
Practice Address - Street 2:SUITE #6
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2193
Practice Address - Country:US
Practice Address - Phone:850-477-7181
Practice Address - Fax:850-477-7197
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2429103T00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74206OtherBCBS
FL74206AMedicare ID - Type Unspecified
FL74206OtherBCBS