MEDICARE: PETRINA MCGOWEN LMFT, RDT

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	106H00000X	Marriage & Family Therapist	MT2331	FL

General Provider Information

NPI Number	:	1942466941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETRINA MCGOWEN LMFT, RDT

Provider Business Mailing Address
First Line	:	3768 NE MELBA DR
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3867
Country	:	US
Telephone Number	:	772-708-2830
Fax Number	:	772-237-3750

Provider Business Practice Location Address
First Line	:	672 SE MONTEREY RD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-4410
Country	:	US
Telephone Number	:	772-708-2830
Fax Number	:	772-237-3750

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

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	09/14/2018

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