Healthcare Provider Details

I. General information

NPI: 1144203670
Provider Name (Legal Business Name): PATRICK G BOWMAN LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 12/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 JEWEL ST APT 3L
BROOKLYN NY
11222-3575
US

IV. Provider business mailing address

67 JEWEL ST APT 3L
BROOKLYN NY
11222-3575
US

V. Phone/Fax

Practice location:
  • Phone: 724-322-6507
  • Fax:
Mailing address:
  • Phone: 724-322-6507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW013673L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076617-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1205995
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: