Provider Demographics
NPI:1598133050
Name:KOWALCHUK, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KOWALCHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DACQUARI DR
Mailing Address - Street 2:
Mailing Address - City:STORMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12582-5703
Mailing Address - Country:US
Mailing Address - Phone:914-329-0845
Mailing Address - Fax:
Practice Address - Street 1:5 DACQUARI DR
Practice Address - Street 2:
Practice Address - City:STORMVILLE
Practice Address - State:NY
Practice Address - Zip Code:12582-5703
Practice Address - Country:US
Practice Address - Phone:914-329-0845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-DMT 2072101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor