Provider Demographics
NPI:1134284300
Name:COLLOCA BOWEN, KATHERINE J (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:J
Last Name:COLLOCA BOWEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FENNAWAY GRN
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-1313
Mailing Address - Country:US
Mailing Address - Phone:315-655-8012
Mailing Address - Fax:
Practice Address - Street 1:105 LEILANIS LN
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3540
Practice Address - Country:US
Practice Address - Phone:607-337-1680
Practice Address - Fax:607-336-1380
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068792-1101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)