Provider Demographics
NPI:1033281720
Name:LOWERY, MARTIN J (MSW, LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:J
Last Name:LOWERY
Suffix:
Gender:M
Credentials:MSW, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:MARYKNOLL
Mailing Address - State:NY
Mailing Address - Zip Code:10545-0305
Mailing Address - Country:US
Mailing Address - Phone:914-941-7636
Mailing Address - Fax:914-944-3695
Practice Address - Street 1:275 E MAIN ST
Practice Address - Street 2:#102
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3030
Practice Address - Country:US
Practice Address - Phone:914-720-0262
Practice Address - Fax:914-944-3626
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053004-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN532M1Medicare ID - Type Unspecified