Provider Demographics
NPI:1063706265
Name:GOWEN, JAMES R (MED, BCBA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:GOWEN
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ATHERTON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-1901
Mailing Address - Country:US
Mailing Address - Phone:781-439-1772
Mailing Address - Fax:978-654-4381
Practice Address - Street 1:22 ATHERTON AVE
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-1901
Practice Address - Country:US
Practice Address - Phone:781-439-1772
Practice Address - Fax:978-654-4381
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4818103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst