Provider Demographics
NPI:1679639140
Name:COWAN, GREGORY ROBERT (LMHC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ROBERT
Last Name:COWAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1377
Mailing Address - Country:US
Mailing Address - Phone:508-644-5243
Mailing Address - Fax:508-235-7346
Practice Address - Street 1:413 HIGH ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3306
Practice Address - Country:US
Practice Address - Phone:508-677-9091
Practice Address - Fax:508-235-7346
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC 12101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health