Individual
AMANDA JEAN NOWAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
134 MAIN ST, PUTNAM, CT 06260-1920
(860) 926-0142
(860) 413-0919
Mailing address
PO BOX 633, PUTNAM, CT 06260-0633
(860) 926-0142
(860) 413-0919
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
003392
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004040564
—
CT
Enumeration date
06/04/2014
Last updated
07/08/2020
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