Provider Demographics
NPI:1588986343
Name:KOWAL, MICHELLE PETERS (JD, PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:PETERS
Last Name:KOWAL
Suffix:
Gender:F
Credentials:JD, PSYD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JD, PSYD
Mailing Address - Street 1:516 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-1437
Mailing Address - Country:US
Mailing Address - Phone:518-432-0432
Mailing Address - Fax:518-583-4247
Practice Address - Street 1:516 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-1437
Practice Address - Country:US
Practice Address - Phone:518-432-0432
Practice Address - Fax:518-583-4247
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017709103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist