1639489586 NPI number — MRS. MEGHAN HORAN BOWSHER LICSW

Table of content: MRS. MEGHAN HORAN BOWSHER LICSW (NPI 1639489586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639489586 NPI number — MRS. MEGHAN HORAN BOWSHER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWSHER
Provider First Name:
MEGHAN
Provider Middle Name:
HORAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HORAN
Provider Other First Name:
MEGHAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639489586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 MILL ST
Provider Second Line Business Mailing Address:
EAST HOUSE
Provider Business Mailing Address City Name:
BELMONT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02478-1064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-855-2842
Provider Business Mailing Address Fax Number:
617-855-3754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MILL ST
Provider Second Line Business Practice Location Address:
EAST HOUSE
Provider Business Practice Location Address City Name:
BELMONT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02478-1064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-855-2842
Provider Business Practice Location Address Fax Number:
617-855-3754
Provider Enumeration Date:
10/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  118233 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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