Provider Demographics
NPI:1093855223
Name:BOWMAN, ROBERT T (LICSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8663
Mailing Address - Fax:304-234-8960
Practice Address - Street 1:2101 JACOB ST STE 501
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3800
Practice Address - Country:US
Practice Address - Phone:304-234-8517
Practice Address - Fax:304-234-8745
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00089301041C0700X
WVDP009385891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000217379OtherANTHEM BCBS
NY357056OtherVALUE OPTIONS
OH275588000OtherMAGELLAN BEHAVIORAL HEALT
WV000701395OtherMOUNTAIN STATE BCBS
WV000701395OtherMOUNTAIN STATE BCBS
P24944Medicare UPIN