Provider Demographics
NPI:1316324775
Name:LOWELL, WARREN (BA)
Entity type:Individual
Prefix:MR
First Name:WARREN
Middle Name:
Last Name:LOWELL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3445
Mailing Address - Country:US
Mailing Address - Phone:617-872-6863
Mailing Address - Fax:
Practice Address - Street 1:1125 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3445
Practice Address - Country:US
Practice Address - Phone:617-872-6863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator