Provider Demographics
NPI:1578604500
Name:NOWINSKI, JOSEPH KENNETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KENNETH
Last Name:NOWINSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MARBELLA LN
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3933
Mailing Address - Country:US
Mailing Address - Phone:860-872-4829
Mailing Address - Fax:860-896-0523
Practice Address - Street 1:24 GOOSE LN
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3417
Practice Address - Country:US
Practice Address - Phone:860-872-4829
Practice Address - Fax:860-896-0523
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT912103T00000X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060000912CT03OtherANTHEM