MEDICARE: MAXENE BOWERS 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	0904003679	VA

General Provider Information

NPI Number	:	1437105152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXENE BOWERS LCSW

Provider Business Mailing Address
First Line	:	800 PRESTON AVE
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22903-4420
Country	:	US
Telephone Number	:	434-972-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 PRESTON AVE
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22903-4420
Country	:	US
Telephone Number	:	434-972-1800
Fax Number	:

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	12/14/2007

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