Provider Demographics
NPI:1619565868
Name:COWAN, NICOLE (MSW, LSW, MPH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:MSW, LSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 N BREAD ST APT 117
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1942
Mailing Address - Country:US
Mailing Address - Phone:240-731-7156
Mailing Address - Fax:
Practice Address - Street 1:535 N CHURCH ST STE 115
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2338
Practice Address - Country:US
Practice Address - Phone:610-209-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health