Provider Demographics
NPI:1437866597
Name:GEORGE-OWENS, AUDREY M (LMSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:M
Last Name:GEORGE-OWENS
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 1:18715 ILION AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-1939
Mailing Address - Country:US
Mailing Address - Phone:646-589-3100
Mailing Address - Fax:
Practice Address - Street 1:18715 ILION AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-1939
Practice Address - Country:US
Practice Address - Phone:646-589-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
NJNJDCATEMP-035233104100000X
CT700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst