Provider Demographics
NPI:1619042868
Name:CAROL L NOWAK PHD INC
Entity type:Organization
Organization Name:CAROL L NOWAK PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-247-0535
Mailing Address - Street 1:45-024 MALULANI ST # 1
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2433
Mailing Address - Country:US
Mailing Address - Phone:808-247-0535
Mailing Address - Fax:808-234-0872
Practice Address - Street 1:45-024 MALULANI ST # 1
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2433
Practice Address - Country:US
Practice Address - Phone:808-247-0535
Practice Address - Fax:808-234-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY473103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02570601Medicaid
50360Medicare ID - Type Unspecified
545884Medicare UPIN