Provider Demographics
NPI:1184895633
Name:RAYMOND KOWALCYK, PH.D.
Entity type:Organization
Organization Name:RAYMOND KOWALCYK, PH.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KOWALCYK
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:610-703-9633
Mailing Address - Street 1:6841 BLUE CHURCH RD S
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-1883
Mailing Address - Country:US
Mailing Address - Phone:610-703-9633
Mailing Address - Fax:610-282-2988
Practice Address - Street 1:6841 BLUE CHURCH RD S
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-1883
Practice Address - Country:US
Practice Address - Phone:610-703-9633
Practice Address - Fax:610-282-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000833L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028105Medicare PIN