Provider Demographics
NPI:1821191016
Name:NOWICKI, MICHAEL J (LICSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:NOWICKI
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2836
Mailing Address - Country:US
Mailing Address - Phone:508-756-4646
Mailing Address - Fax:508-791-4755
Practice Address - Street 1:31 HARVARD ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2836
Practice Address - Country:US
Practice Address - Phone:508-756-4646
Practice Address - Fax:508-791-4755
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1030980Medicare UPIN
MAPO4173Medicare UPIN
MAPO4173Medicare ID - Type Unspecified