Healthcare Provider Details

I. General information

NPI: 1629803861
Provider Name (Legal Business Name): HEATHER M. BOWMAN, LCSW, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EDWARD ST APT 3B
BUFFALO NY
14201-2131
US

IV. Provider business mailing address

125 EDWARD ST APT 3B
BUFFALO NY
14201-2131
US

V. Phone/Fax

Practice location:
  • Phone: 917-770-1919
  • Fax:
Mailing address:
  • Phone: 917-770-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. HEATHER MARIE BOWMAN
Title or Position: PRESIDENT
Credential: LCSW
Phone: 917-770-1919