Provider Demographics
NPI:1346292661
Name:NOWIK, ALISA CASTLETON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:CASTLETON
Last Name:NOWIK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ALISA
Other - Middle Name:NOWIK
Other - Last Name:STERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3036 REGENT STREET
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2551
Mailing Address - Country:US
Mailing Address - Phone:650-644-5358
Mailing Address - Fax:888-841-0506
Practice Address - Street 1:3036 REGENT STREET
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2551
Practice Address - Country:US
Practice Address - Phone:650-644-5358
Practice Address - Fax:888-841-0506
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21587103TC0700X, 103TC2200X
NY016438103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016438OtherNYS PSYD LICENSE #
PSY 21587OtherCA LICENSE
NY00355940Medicaid
CA461699OtherMHN INSURANCE