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General NPI Number Information
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NPI Number | 1740417567
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Entity Type | Individual
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Provider Name | ROBERT FOWLER LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 25 MIDDLE ST
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City | PORTLAND
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State | ME
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Zip | 04101-4869
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Country | US
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Telephone | 207-232-4112
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Fax |
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Provider Business Mailing Address
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Address Line | 15 HIGHVIEW DR
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City | NEW GLOUCESTER
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State | ME
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Zip | 04260-4034
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Country | US
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Telephone | 207-232-4112
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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 | LC8950
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License Number State | ME
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