Provider Demographics
NPI:1477760411
Name:FOWLER, JOANNE LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:LYNNE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1210 PONTIAC AVE
Mailing Address - Street 2:INSTITUTE FOR BEHAVIORAL MEDICINE 3RD FLOOR
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4490
Mailing Address - Country:US
Mailing Address - Phone:401-461-7547
Mailing Address - Fax:401-781-4570
Practice Address - Street 1:1210 PONTIAC AVE
Practice Address - Street 2:INSTITUTE FOR BEHAVIORAL MEDICINE 3RD FLOOR
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4490
Practice Address - Country:US
Practice Address - Phone:401-461-7547
Practice Address - Fax:401-781-4570
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPS00229103TC0700X
MA5064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical