Provider Demographics
NPI:1255319737
Name:KOWALSKI, VINCENT THOMAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:THOMAS
Last Name:KOWALSKI
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 1:69 PERKIOMEN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2018
Mailing Address - Country:US
Mailing Address - Phone:718-967-1730
Mailing Address - Fax:
Practice Address - Street 1:69 PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2018
Practice Address - Country:US
Practice Address - Phone:718-967-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0399961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical