MEDICARE: MRS. PATRICIA MARIE BOWLES-LYONS LCSW, LP

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	101YM0800X	Mental Health Counselor	R027661-1	NY
2	1041C0700X	Clinical Social Worker	R027661-1	NY
3	1041C0700X	Clinical Social Worker	000468-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000468-1	OTHER	NY	PSYCHOANALYST LICENSE
2	R027661-1	OTHER	NY	LCSW LICENSE

General Provider Information

NPI Number	:	1598782195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA MARIE BOWLES-LYONS LCSW, LP

Provider Business Mailing Address
First Line	:	191 JORALEMON ST
Second Line	:	14TH FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4306
Country	:	US
Telephone Number	:	718-722-6146
Fax Number	:	718-722-6217

Provider Business Practice Location Address
First Line	:	191 JORALEMON ST
Second Line	:	14TH FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4306
Country	:	US
Telephone Number	:	718-722-6146
Fax Number	:	718-722-6217

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	09/04/2014

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