Provider Demographics
NPI:1275033631
Name:NOWAK, ESTELLE KAY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:ESTELLE
Middle Name:KAY
Last Name:NOWAK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 SHOREWOOD DR UNIT A206
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-5080
Mailing Address - Country:US
Mailing Address - Phone:321-313-2139
Mailing Address - Fax:
Practice Address - Street 1:5445 VILLAGE DR STE 102
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32955-6666
Practice Address - Country:US
Practice Address - Phone:321-313-2139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health