Provider Demographics
NPI:1942615919
Name:POMICHOWSKA, MALWINA (TECH)
Entity type:Individual
Prefix:
First Name:MALWINA
Middle Name:
Last Name:POMICHOWSKA
Suffix:
Gender:F
Credentials:TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-2324
Mailing Address - Country:US
Mailing Address - Phone:800-218-9280
Mailing Address - Fax:
Practice Address - Street 1:100 W BIG BEAVER RD STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5283
Practice Address - Country:US
Practice Address - Phone:615-570-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other