Provider Demographics
NPI:1548297799
Name:NOWACZYK, CAROLINE (LMSW)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:NOWACZYK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1539
Mailing Address - Country:US
Mailing Address - Phone:989-672-6160
Mailing Address - Fax:989-672-6272
Practice Address - Street 1:3741 WILDER RD
Practice Address - Street 2:SUITE A
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2343
Practice Address - Country:US
Practice Address - Phone:989-460-1000
Practice Address - Fax:989-460-1003
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010605341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG96288053Medicare PIN