Healthcare Provider Details

I. General information

NPI: 1801262928
Provider Name (Legal Business Name): MARQUITA BOWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARQUITA BOWEN CASAC ADV

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 OLD LIVERPOOL RD STE 9
LIVERPOOL NY
13088-6285
US

IV. Provider business mailing address

526 OLD LIVERPOOL RD STE 9
LIVERPOOL NY
13088-6285
US

V. Phone/Fax

Practice location:
  • Phone: 315-280-0400
  • Fax: 315-280-0087
Mailing address:
  • Phone: 315-453-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number29805
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: