Healthcare Provider Details

I. General information

NPI: 1609262609
Provider Name (Legal Business Name): JESSICA LOWRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 W PHILADELPHIA ST
YORK PA
17401-6509
US

IV. Provider business mailing address

815 E MAIN ST
DALLASTOWN PA
17313-9714
US

V. Phone/Fax

Practice location:
  • Phone: 717-845-2425
  • Fax:
Mailing address:
  • Phone: 504-224-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017828
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: