MEDICARE: CELESTE BOWMAN MS, CAP,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	11515	NY
2	101YM0800X	Mental Health Counselor	IMH20242	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IMH20242	OTHER	FL	FLORIDA CERTIFICATION BOARD
2	009621-2015	OTHER	FL	FLORIDA CERTIFICATION BOARD

General Provider Information

NPI Number	:	1396971420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTE BOWMAN MS, CAP,

Provider Business Mailing Address
First Line	:	3490 QUANTUM LAKES DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8340
Country	:	US
Telephone Number	:	718-213-6680
Fax Number	:

Provider Business Practice Location Address
First Line	:	3490 QUANTUM LAKES DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8340
Country	:	US
Telephone Number	:	718-213-6680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	12/28/2020

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