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General NPI Number Information
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NPI Number | 1245998905
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Entity Type | Individual
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Provider Name | DORA GLENN BOWMAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 3945 49TH ST
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City | SUNNYSIDE
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State | NY
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Zip | 11104-1023
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Country | US
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Telephone | 646-286-5835
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Fax |
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Provider Business Mailing Address
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Address Line | 2855 TELEGRAPH AVE STE 515
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City | BERKELEY
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State | CA
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Zip | 94705-1151
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Country | US
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Telephone |
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 091825
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License Number State | NY
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