MEDICARE: MR. JIMMY OWENS LICSW

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	1027372	MA

General Provider Information

NPI Number	:	1982890794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JIMMY OWENS LICSW

Provider Business Mailing Address
First Line	:	14 SHIRLEY ST
Second Line	:	UNIT C-1
City	:	NEW BEDFORD
State	:	MA
Zip	:	02746-1150
Country	:	US
Telephone Number	:	508-993-5113
Fax Number	:	508-984-3389

Provider Business Practice Location Address
First Line	:	14 SHIRLEY ST
Second Line	:	UNIT C-1
City	:	NEW BEDFORD
State	:	MA
Zip	:	02746-1150
Country	:	US
Telephone Number	:	508-993-5113
Fax Number	:	508-984-3389

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

Provider Enumeration Date	:	09/15/2007
Last Update Date	:	04/14/2017

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