Provider Demographics
NPI:1215385679
Name:COWLES, KRISTEN REGAN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:REGAN
Last Name:COWLES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TOTMAN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7509
Mailing Address - Country:US
Mailing Address - Phone:617-745-0050
Mailing Address - Fax:617-745-0052
Practice Address - Street 1:21 TOTMAN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7509
Practice Address - Country:US
Practice Address - Phone:617-745-0050
Practice Address - Fax:617-745-0052
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107702104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker