Provider Demographics
NPI:1255516563
Name:NOWAK, CAROL L (PHD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:NOWAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-024 MALULANI ST # 1
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2433
Mailing Address - Country:US
Mailing Address - Phone:808-247-0535
Mailing Address - Fax:808-234-0872
Practice Address - Street 1:45-024 MALULANI ST # 1
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2433
Practice Address - Country:US
Practice Address - Phone:808-247-0535
Practice Address - Fax:808-234-0872
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical