Provider Demographics
NPI:1992464879
Name:LOWERY, KEVIN (MSW)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:LOWERY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-7000
Mailing Address - Country:US
Mailing Address - Phone:602-325-5580
Mailing Address - Fax:
Practice Address - Street 1:6611 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-7000
Practice Address - Country:US
Practice Address - Phone:602-325-5580
Practice Address - Fax:602-926-1382
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-15220104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker