Provider Demographics
NPI:1225724024
Name:FOWLER, EMILY CARMELLA
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CARMELLA
Last Name:FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 34TH AVENUE DR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-4452
Mailing Address - Country:US
Mailing Address - Phone:703-965-9016
Mailing Address - Fax:
Practice Address - Street 1:300 34TH AVENUE DR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-4452
Practice Address - Country:US
Practice Address - Phone:703-965-9016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health