Provider Demographics
NPI:1083618037
Name:MCDOWELL, PHILIP ESTABROOKS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ESTABROOKS
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7743 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1228
Mailing Address - Country:US
Mailing Address - Phone:315-771-7649
Mailing Address - Fax:315-376-7649
Practice Address - Street 1:7743 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1228
Practice Address - Country:US
Practice Address - Phone:315-771-7649
Practice Address - Fax:315-376-7649
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR01693211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R55764Medicare UPIN
IA0601Medicare ID - Type Unspecified