Provider Demographics
NPI:1457437212
Name:MICHALOWSKI, JOHN R (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:MICHALOWSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 METOXET ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-1919
Mailing Address - Country:US
Mailing Address - Phone:814-903-0010
Mailing Address - Fax:
Practice Address - Street 1:9 S MILL AVE APT 3
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-1043
Practice Address - Country:US
Practice Address - Phone:814-594-6829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0125851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA036857GB3Medicare PIN