Provider Demographics
NPI:1881679637
Name:NOWAKOWSKI, CAROLYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:NOWAKOWSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16325 HARLEM AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2509
Mailing Address - Country:US
Mailing Address - Phone:708-429-6999
Mailing Address - Fax:708-429-6909
Practice Address - Street 1:16325 HARLEM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2509
Practice Address - Country:US
Practice Address - Phone:708-429-6999
Practice Address - Fax:708-429-6909
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
593650Medicare ID - Type Unspecified
P13173Medicare UPIN