Provider Demographics
NPI:1396984811
Name:BOWCOCK, AMANDA LOREE (LMHC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LOREE
Last Name:BOWCOCK
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 1:430 MAIN ST STE 8
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-3521
Mailing Address - Country:US
Mailing Address - Phone:631-747-0351
Mailing Address - Fax:631-909-3558
Practice Address - Street 1:430 MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3521
Practice Address - Country:US
Practice Address - Phone:631-747-0351
Practice Address - Fax:631-909-3558
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist