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General NPI Number Information
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NPI Number | 1104330216
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Entity Type | Individual
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Provider Name | DONALD FREDERIC BOWERSOX LMSW
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Gender | Male
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 780 HARRY L DR
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City | JOHNSON CITY
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State | NY
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Zip | 13790-1036
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Country | US
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Telephone | 607-729-7777
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Fax | 607-729-7779
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Provider Business Mailing Address
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Address Line | 780 HARRY L DR
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City | JOHNSON CITY
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State | NY
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Zip | 13790-1036
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Country | US
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Telephone | 607-729-7777
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Fax | 607-729-7779
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 101483-1
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License Number State | NY
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