Provider Demographics
NPI:1497837884
Name:BOWYER, PAMELA S (ACSW, LCSW, MAC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:BOWYER
Suffix:
Gender:F
Credentials:ACSW, LCSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 26TH ST W
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1705
Mailing Address - Country:US
Mailing Address - Phone:941-752-7773
Mailing Address - Fax:941-752-7774
Practice Address - Street 1:4802 26TH ST W
Practice Address - Street 2:SUITE C
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1705
Practice Address - Country:US
Practice Address - Phone:941-752-7773
Practice Address - Fax:941-752-7774
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW44371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7558OtherBLUE CROSS BLUE SHILED
FLZ7558OtherBLUE CROSS BLUE SHILED