MEDICARE: ELIZABETH ROSE BOWEN LCSW

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	1041C0700X	Clinical Social Worker	104650	TX

General Provider Information

NPI Number	:	1407575319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ROSE BOWEN LCSW

Provider Business Mailing Address
First Line	:	5600 BLACKMON CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-3773
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 BLACKMON CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-3773
Country	:	US
Telephone Number	:	214-205-0596
Fax Number	:

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

Provider Enumeration Date	:	08/24/2022
Last Update Date	:	08/06/2024

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