Provider Demographics
NPI:1417518952
Name:NOWACK, BRIAN (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:NOWACK
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 1:180A TICES LN STE 202
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1395
Mailing Address - Country:US
Mailing Address - Phone:732-354-0050
Mailing Address - Fax:732-325-0334
Practice Address - Street 1:180A TICES LN STE 202
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1395
Practice Address - Country:US
Practice Address - Phone:732-354-0050
Practice Address - Fax:732-325-0334
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC061130001041C0700X
NJ44SL04987600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker