Healthcare Provider Details

I. General information

NPI: 1619718913
Provider Name (Legal Business Name): EILEEN OWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 CONEY ISLAND AVE
BROOKLYN NY
11230-4166
US

IV. Provider business mailing address

1375 CONEY ISLAND AVENUE PMB 1035
BROOKLYN NY
11230
US

V. Phone/Fax

Practice location:
  • Phone: 914-987-1694
  • Fax:
Mailing address:
  • Phone: 914-987-1694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: