Provider Demographics
NPI:1164876108
Name:KOWALCHUK, BERNADETTE A (MFT)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:A
Last Name:KOWALCHUK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 UNION ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4498
Mailing Address - Country:US
Mailing Address - Phone:201-652-5114
Mailing Address - Fax:
Practice Address - Street 1:174 UNION ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4498
Practice Address - Country:US
Practice Address - Phone:201-652-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3TP15-014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist