Provider Demographics
NPI:1629196027
Name:SOWELL, NANCY (LICSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SOWELL
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 1:17 STRAND WAY
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-4024
Mailing Address - Country:US
Mailing Address - Phone:508-540-7007
Mailing Address - Fax:508-540-7007
Practice Address - Street 1:22 GIFFORD ST
Practice Address - Street 2:SUITE A
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3303
Practice Address - Country:US
Practice Address - Phone:508-540-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10246221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07096OtherBCBS
MA766244OtherTUFTS HEALTH PLAN
MAP20073Medicare ID - Type Unspecified