Provider Demographics
NPI:1821522889
Name:BOROWITZ, WAYNE (SAC-IT)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:BOROWITZ
Suffix:
Gender:M
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4001
Mailing Address - Country:US
Mailing Address - Phone:920-435-2093
Mailing Address - Fax:920-435-2580
Practice Address - Street 1:621 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4001
Practice Address - Country:US
Practice Address - Phone:920-435-2093
Practice Address - Fax:920-435-2580
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17581-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)