Provider Demographics
NPI:1174361646
Name:KOWALSKI, BRAJAN KAJETAN (RCSWI)
Entity type:Individual
Prefix:
First Name:BRAJAN
Middle Name:KAJETAN
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 RIVER PRESERVE CT
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-7464
Mailing Address - Country:US
Mailing Address - Phone:941-363-1442
Mailing Address - Fax:
Practice Address - Street 1:4837 SWIFT RD STE 110-9
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5182
Practice Address - Country:US
Practice Address - Phone:614-500-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW20560104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker