MEDICARE: CAROL L BOWEN MSW, LSW

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	104100000X	Social Worker	SW122879	PA

General Provider Information

NPI Number	:	1487725131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL L BOWEN MSW, LSW

Provider Business Mailing Address
First Line	:	10 BROADWAY AVE
Second Line	:
City	:	NORTH IRWIN
State	:	PA
Zip	:	15642-3305
Country	:	US
Telephone Number	:	724-864-5993
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 CENTRAL CITY PLZ
Second Line	:
City	:	NEW KENSINGTON
State	:	PA
Zip	:	15068-6441
Country	:	US
Telephone Number	:	724-335-9883
Fax Number	:	724-335-2730

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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