Provider Demographics
NPI:1659317477
Name:PETERS-BOWDEN, KAREN L (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:PETERS-BOWDEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MR
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:PETERS-BOWDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1107 PONTIAC AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-7919
Mailing Address - Country:US
Mailing Address - Phone:401-559-5537
Mailing Address - Fax:401-559-5537
Practice Address - Street 1:1107 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-7919
Practice Address - Country:US
Practice Address - Phone:401-559-5537
Practice Address - Fax:401-615-5172
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01478104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker