Provider Demographics
NPI:1598918815
Name:BOWLES, KRISTIN KADRA (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:KADRA
Last Name:BOWLES
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:KADRA
Other - Last Name:MULVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:105 EASTERN AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4555
Mailing Address - Country:US
Mailing Address - Phone:617-763-8091
Mailing Address - Fax:
Practice Address - Street 1:105 EASTERN AVE STE 207
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4555
Practice Address - Country:US
Practice Address - Phone:617-763-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1170971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical