=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154413268
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERYL A FOWLER LCSWR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1322 GERLING ST
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12308-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-346-3334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2835 FORD AVE
-----------------------------------------------------
City | ROTTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12306-1627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-377-6450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | R033104-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------