Provider Demographics
NPI:1104832104
Name:STOWE, MICHAEL TIMOTHY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TIMOTHY
Last Name:STOWE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 GRAMATAN AVE
Mailing Address - Street 2:SUITE ST-O
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1839
Mailing Address - Country:US
Mailing Address - Phone:914-668-6621
Mailing Address - Fax:914-663-4130
Practice Address - Street 1:625 GRAMATAN AVE
Practice Address - Street 2:SUITE ST-O
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-1839
Practice Address - Country:US
Practice Address - Phone:914-668-6621
Practice Address - Fax:914-663-4130
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012979103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
6804423OtherGHI
012979A37OtherHEALTHFIRST
P12007734OtherMULTIPLAN
NY02131313Medicaid
P2352570OtherOXFORD HEALTH PLANS
V161X2OtherEMPIRE BLUE CROSS BLUE SH
19286OtherCARE MANAGEMENT ORGANIZAT
55247OtherHIP PAPER ID
14026595OtherAFFINITY HEALTHCARE
7694267OtherAETNA US HEALTHCARE
87726OtherUNITED BEHAVIORAL HEALTH
01297968OtherHIP OF NEW YORK
OH2319OtherHEALTHNET
2573709OtherAETNA US HEALTHCARE HMO
14026595OtherAFFINITY HEALTHCARE
P12007734OtherMULTIPLAN