Provider Demographics
NPI:1518410976
Name:COLLERAN BOWE, MARYANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:COLLERAN BOWE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-0344
Mailing Address - Country:US
Mailing Address - Phone:781-326-4080
Mailing Address - Fax:
Practice Address - Street 1:59 ELLIS ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-3601
Practice Address - Country:US
Practice Address - Phone:781-326-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1197691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical