Provider Demographics
NPI:1003861741
Name:BOWLING, CHRISTINE PAVLAKIS (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:PAVLAKIS
Last Name:BOWLING
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MUZZEY STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421
Mailing Address - Country:US
Mailing Address - Phone:781-860-0289
Mailing Address - Fax:781-860-0289
Practice Address - Street 1:10 MUZZEY STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421
Practice Address - Country:US
Practice Address - Phone:781-860-0289
Practice Address - Fax:781-860-0289
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1067091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04404Medicare PIN