Provider Demographics
NPI:1386997278
Name:KOWALCZYK, MICHAEL ADAM (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ADAM
Last Name:KOWALCZYK
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2471
Mailing Address - Country:US
Mailing Address - Phone:732-261-6691
Mailing Address - Fax:
Practice Address - Street 1:296 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2471
Practice Address - Country:US
Practice Address - Phone:732-261-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053662001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical