Provider Demographics
NPI:1699711259
Name:BOWER, REGINA E (LICSW)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:E
Last Name:BOWER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:REGINA
Other - Middle Name:E
Other - Last Name:BOWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:27 ATWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-6029
Mailing Address - Country:US
Mailing Address - Phone:781-467-8386
Mailing Address - Fax:
Practice Address - Street 1:27 ATWOOD ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482
Practice Address - Country:US
Practice Address - Phone:781-467-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10251431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1025143OtherLICSW