Provider Demographics
NPI:1790853992
Name:BOWEN NEWTON, VANESSA C (LMHC 5478)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:C
Last Name:BOWEN NEWTON
Suffix:
Gender:F
Credentials:LMHC 5478
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 DORCHESTER AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1301
Mailing Address - Country:US
Mailing Address - Phone:617-265-5064
Mailing Address - Fax:617-265-5179
Practice Address - Street 1:1485 DORCHESTER AVE STE 206
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1301
Practice Address - Country:US
Practice Address - Phone:617-265-5064
Practice Address - Fax:617-265-5179
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5478101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1467768325OtherNPI