Provider Demographics
NPI:1154370617
Name:NOWAK, SONIA MARY (MSW)
Entity type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:MARY
Last Name:NOWAK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 BURSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RIEGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18077-9747
Mailing Address - Country:US
Mailing Address - Phone:610-346-8775
Mailing Address - Fax:
Practice Address - Street 1:1600 LEHIGH PKWY E
Practice Address - Street 2:SUITE 1F
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3000
Practice Address - Country:US
Practice Address - Phone:610-821-7790
Practice Address - Fax:610-821-1243
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW 001012 L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03080601OtherCAP BLUE CROSS
PANO 634559Medicare ID - Type Unspecified