MEDICARE: CHARISSE REGENE BOWMAN 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	CW024834	PA
2	104100000X	Social Worker	SW123374	PA

General Provider Information

NPI Number	:	1437175304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISSE REGENE BOWMAN LCSW

Provider Business Mailing Address
First Line	:	342 N JEFFERSON AVE
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-1247
Country	:	US
Telephone Number	:	724-469-2171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 INTERMEDIATE UNIT DR
Second Line	:
City	:	COAL CENTER
State	:	PA
Zip	:	15423-1000
Country	:	US
Telephone Number	:	724-938-3241
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	02/28/2025

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Directions to “ CHARISSE REGENE BOWMAN LCSW” Practice Location

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