Provider Demographics
NPI:1932073699
Name:BOWLES, RONIQUE D
Entity type:Individual
Prefix:
First Name:RONIQUE
Middle Name:D
Last Name:BOWLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 FULTON ST APT 4K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1220
Mailing Address - Country:US
Mailing Address - Phone:631-455-0430
Mailing Address - Fax:
Practice Address - Street 1:1670 FULTON ST APT 4K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1220
Practice Address - Country:US
Practice Address - Phone:631-455-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health