=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023055142
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY BROOKS BOWE MSW,ACSW,LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 CORAL AVE
-----------------------------------------------------
City | GOLDSTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27252-9606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-898-2300
-----------------------------------------------------
Fax | 919-898-4800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8207 ORANGE GROVE RD
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27516-8887
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-929-5040
-----------------------------------------------------
Fax | 919-942-6884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1041C0700X
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------