Provider Demographics
NPI:1346712031
Name:NOWAK, CATHLEEN JULIA (MSW)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:JULIA
Last Name:NOWAK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TROTTERS GLN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2748
Mailing Address - Country:US
Mailing Address - Phone:860-878-2913
Mailing Address - Fax:
Practice Address - Street 1:10 TROTTERS GLN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2748
Practice Address - Country:US
Practice Address - Phone:860-878-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4472104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker