Provider Demographics
NPI:1487978805
Name:KOWALSKI, JENNIFER CHERIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CHERIE
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 SAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4718
Mailing Address - Country:US
Mailing Address - Phone:860-343-5303
Mailing Address - Fax:860-344-3339
Practice Address - Street 1:681 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4718
Practice Address - Country:US
Practice Address - Phone:860-343-5303
Practice Address - Fax:860-344-3339
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1865101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008002733Medicaid