Healthcare Provider Details

I. General information

NPI: 1932851136
Provider Name (Legal Business Name): MICHELE VICTORIA BOWNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 CROWE AVE
MARS PA
16046-3303
US

IV. Provider business mailing address

195 CROWE AVE
MARS PA
16046-3303
US

V. Phone/Fax

Practice location:
  • Phone: 724-252-4637
  • Fax:
Mailing address:
  • Phone: 724-252-4637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23624
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW022365
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: