Provider Demographics
NPI:1306905252
Name:BOWIE, SALLY INDEPENDENCE (LICSW)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:INDEPENDENCE
Last Name:BOWIE
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 1:6 BARBERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8004
Mailing Address - Country:US
Mailing Address - Phone:781-674-9124
Mailing Address - Fax:781-674-9126
Practice Address - Street 1:10 MUZZEY ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5222
Practice Address - Country:US
Practice Address - Phone:781-674-9124
Practice Address - Fax:781-674-9126
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102804104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02455OtherBCBS
MAP21943Medicare ID - Type Unspecified