Provider Demographics
NPI:1043348253
Name:BOWER, ELEANOR A (LCSW)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:A
Last Name:BOWER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1898 W C 476
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-3524
Mailing Address - Country:US
Mailing Address - Phone:352-793-4126
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:119 N MARKET ST
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-6107
Practice Address - Country:US
Practice Address - Phone:352-793-4126
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 24541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768183600Medicaid
FLAC851OtherMEDICARE PTAN