Healthcare Provider Details

I. General information

NPI: 1437175304
Provider Name (Legal Business Name): CHARISSE REGENE BOWMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARISSE REGENE MARTIN LSW

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INTERMEDIATE UNIT DR
COAL CENTER PA
15423-1000
US

IV. Provider business mailing address

342 N JEFFERSON AVE
CANONSBURG PA
15317-1247
US

V. Phone/Fax

Practice location:
  • Phone: 724-938-3241
  • Fax:
Mailing address:
  • Phone: 724-469-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW024834
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW123374
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: