Provider Demographics
NPI:1104932151
Name:LOWRY, JODI SUE (LCSW-R, ACSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:SUE
Last Name:LOWRY
Suffix:
Gender:F
Credentials:LCSW-R, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 VESTAL PKWY E
Mailing Address - Street 2:SUITE E
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2154
Mailing Address - Country:US
Mailing Address - Phone:607-729-3003
Mailing Address - Fax:607-729-3004
Practice Address - Street 1:3209 VESTAL PKWY E
Practice Address - Street 2:SUITE E
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2154
Practice Address - Country:US
Practice Address - Phone:607-729-3003
Practice Address - Fax:607-729-3004
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0539151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC1101Medicare ID - Type Unspecified