Provider Demographics
NPI:1063626604
Name:BOWEN, EARL (MSW)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:
Last Name:BOWEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:EARL
Other - Middle Name:
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:141 RUE ST JACQUES
Mailing Address - Street 2:
Mailing Address - City:LINE LEXINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18932-9526
Mailing Address - Country:US
Mailing Address - Phone:215-757-6916
Mailing Address - Fax:
Practice Address - Street 1:141 RUE ST JACQUES
Practice Address - Street 2:
Practice Address - City:LINE LEXINGTON
Practice Address - State:PA
Practice Address - Zip Code:18932-9526
Practice Address - Country:US
Practice Address - Phone:215-757-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health