Healthcare Provider Details

I. General information

NPI: 1477854636
Provider Name (Legal Business Name): JEFFREY BOWDEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 ROUTE 18
EAST BRUNSWICK NJ
08816-1913
US

IV. Provider business mailing address

223 ROUTE 18
EAST BRUNSWICK NJ
08816-1913
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-8110
  • Fax: 732-445-0130
Mailing address:
  • Phone: 732-246-8110
  • Fax: 732-445-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00294500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: