Provider Demographics
NPI:1891822912
Name:SOLOMOWITZ, NORMAN (PHD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:SOLOMOWITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 ANNANDALE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1778
Mailing Address - Country:US
Mailing Address - Phone:209-952-9475
Mailing Address - Fax:209-952-9475
Practice Address - Street 1:4227 ANNANDALE DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-1778
Practice Address - Country:US
Practice Address - Phone:209-952-9475
Practice Address - Fax:209-952-9475
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 6514OtherSTATE LICENSE
CAPSY 0065140Medicare ID - Type UnspecifiedMEDICARE