Provider Demographics
NPI:1598891442
Name:NOWAKOWSKI, MARK EDWARD (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:EDWARD
Last Name:NOWAKOWSKI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
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Mailing Address - Street 1:165 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3049
Mailing Address - Country:US
Mailing Address - Phone:607-753-0234
Mailing Address - Fax:607-753-0286
Practice Address - Street 1:10 CAMBRIDGE AVE.
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NY
Practice Address - Zip Code:13408
Practice Address - Country:US
Practice Address - Phone:315-684-1172
Practice Address - Fax:315-684-1200
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0781121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336163963Medicaid