Provider Demographics
NPI:1568945467
Name:BOWMAN, ELIZABETH WYATT (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WYATT
Last Name:BOWMAN
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 1:13 SHEEP PASTURE WAY
Mailing Address - Street 2:
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1568
Mailing Address - Country:US
Mailing Address - Phone:774-338-5615
Mailing Address - Fax:
Practice Address - Street 1:13 SHEEP PASTURE WAY
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1568
Practice Address - Country:US
Practice Address - Phone:774-338-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1193761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical