Provider Demographics
NPI:1477876621
Name:SIMON-BOWER, LOURDES (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:SIMON-BOWER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 BERESFORD RD W
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-1116
Mailing Address - Country:US
Mailing Address - Phone:561-346-2314
Mailing Address - Fax:
Practice Address - Street 1:2721 POINSETTIA AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5503
Practice Address - Country:US
Practice Address - Phone:561-653-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSW737104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPSW 737OtherPROVISIONAL CLINICAL SOCIAL WORKER LICENSE