Provider Demographics
NPI:1033625603
Name:OWEN, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OWEN
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 1:37 GLENBROOK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2913
Mailing Address - Country:US
Mailing Address - Phone:203-693-4917
Mailing Address - Fax:
Practice Address - Street 1:37 GLENBROOK RD STE 3
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2913
Practice Address - Country:US
Practice Address - Phone:203-693-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty