Provider Demographics
NPI:1114439759
Name:BOWEN, SUSAN ANN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:BOWEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COOK RD
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-5627
Mailing Address - Country:US
Mailing Address - Phone:508-693-7900
Mailing Address - Fax:
Practice Address - Street 1:15 COOK RD
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-5627
Practice Address - Country:US
Practice Address - Phone:508-693-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health