Provider Demographics
NPI:1760877872
Name:BOWMAN-VICKERS, CATHY-JO (LSW)
Entity Type:Individual
Prefix:MRS
First Name:CATHY-JO
Middle Name:
Last Name:BOWMAN-VICKERS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:CATHY-JO
Other - Middle Name:
Other - Last Name:VICKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA; MHRT-C
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0990
Mailing Address - Country:US
Mailing Address - Phone:207-612-6071
Mailing Address - Fax:
Practice Address - Street 1:347 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-4238
Practice Address - Country:US
Practice Address - Phone:207-612-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS13767104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker