Provider Demographics
NPI:1285872101
Name:BOWEN, KATE (LMHC)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BULLOCKS POINT AVENUE SUITE B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915
Mailing Address - Country:US
Mailing Address - Phone:617-872-4591
Mailing Address - Fax:401-270-1824
Practice Address - Street 1:205 BULLOCKS POINT AVENUE SUITE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:617-872-4591
Practice Address - Fax:401-270-1824
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00408101YM0800X
MA5826101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKB74642Medicaid