Provider Demographics
NPI:1598300923
Name:KOWARA, JUSTINA (MA)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:KOWARA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 TRAILAWAY LN
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33417-5833
Mailing Address - Country:US
Mailing Address - Phone:718-427-3306
Mailing Address - Fax:
Practice Address - Street 1:1121 TRAILAWAY LN
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:FL
Practice Address - Zip Code:33417-5833
Practice Address - Country:US
Practice Address - Phone:718-427-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty