Provider Demographics
NPI:1235383944
Name:FOWLER, DONNA CARLEEN (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:CARLEEN
Last Name:FOWLER
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 1:133 SARATOGA RD
Mailing Address - Street 2:APT. Y-8
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4108
Mailing Address - Country:US
Mailing Address - Phone:518-399-3957
Mailing Address - Fax:
Practice Address - Street 1:100 SARATOGA VILLAGE BLVD
Practice Address - Street 2:STE. 35
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-3737
Practice Address - Country:US
Practice Address - Phone:518-899-9235
Practice Address - Fax:518-899-9315
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055268-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker