Provider Demographics
NPI:1588800569
Name:NOWAKOWSKI, THERESA M (LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:NOWAKOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 FARMINGTON AVE
Mailing Address - Street 2:SUITE 217 B
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1505
Mailing Address - Country:US
Mailing Address - Phone:860-523-9420
Mailing Address - Fax:860-667-3369
Practice Address - Street 1:9 STONEGATE
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1469
Practice Address - Country:US
Practice Address - Phone:860-674-1782
Practice Address - Fax:860-418-6699
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0067221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical