Provider Demographics
NPI:1467755025
Name:SCOTT FOWLER, MARVELYN ANN (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:MARVELYN
Middle Name:ANN
Last Name:SCOTT FOWLER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MRS
Other - First Name:MARVELYN
Other - Middle Name:ANN
Other - Last Name:SCOTT FOWLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:3104 EAGLES NEST DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3917
Mailing Address - Country:US
Mailing Address - Phone:301-741-0380
Mailing Address - Fax:301-464-1939
Practice Address - Street 1:3104 EAGLES NEST DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3917
Practice Address - Country:US
Practice Address - Phone:301-741-0380
Practice Address - Fax:301-464-1939
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD053641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical