Provider Demographics
NPI:1356483085
Name:COWAL, EDWARD (LICSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:COWAL
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 1:10 CEDAR ST
Mailing Address - Street 2:SUITE 34
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6364
Mailing Address - Country:US
Mailing Address - Phone:781-944-2028
Mailing Address - Fax:617-889-8509
Practice Address - Street 1:10 CEDAR ST
Practice Address - Street 2:SUITE 34
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6364
Practice Address - Country:US
Practice Address - Phone:781-944-2028
Practice Address - Fax:617-889-8509
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1051551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPP0165Medicare ID - Type UnspecifiedPROVIDER NUMBER