Provider Demographics
NPI:1679714372
Name:SOW, ETHELORE CHIOMA (MSW)
Entity Type:Individual
Prefix:MS
First Name:ETHELORE
Middle Name:CHIOMA
Last Name:SOW
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1893 7TH AVE
Mailing Address - Street 2:6B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2821
Mailing Address - Country:US
Mailing Address - Phone:212-395-2140
Mailing Address - Fax:212-305-8210
Practice Address - Street 1:21 AUDUBON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4220
Practice Address - Country:US
Practice Address - Phone:212-305-2140
Practice Address - Fax:212-305-8210
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730363971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical