Provider Demographics
NPI:1043432933
Name:LOWELL, MARY ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:LOWELL
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 1:280 MADISON AVENUE
Mailing Address - Street 2:SUITE 1108
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-679-3171
Mailing Address - Fax:212-679-3172
Practice Address - Street 1:280 MADISON AVENUE
Practice Address - Street 2:SUITE 1108
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-679-3171
Practice Address - Fax:212-679-3172
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0582721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2989912OtherOXFORD PROVIDER ID
NYN467A1Medicare ID - Type Unspecified