Provider Demographics
NPI:1720500622
Name:POPOWICH, MICHAEL JR (LMSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:POPOWICH
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-9402
Mailing Address - Country:US
Mailing Address - Phone:718-798-7801
Mailing Address - Fax:
Practice Address - Street 1:2250 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9402
Practice Address - Country:US
Practice Address - Phone:718-798-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099287-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker