MEDICARE: COURTNEY GOWEN 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	19160	FL
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1508489915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY GOWEN LCSW

Provider Business Mailing Address
First Line	:	3825 HENDERSON BLVD STE 405
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5012
Country	:	US
Telephone Number	:	813-445-3099
Fax Number	:

Provider Business Practice Location Address
First Line	:	5331 PRIMROSE LAKE CIR STE 209
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3751
Country	:	US
Telephone Number	:	727-871-7665
Fax Number	:

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

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	10/04/2023

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