Provider Demographics
NPI:1811389067
Name:ROWE, KINGSLEY
Entity Type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:
Last Name:ROWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7312 35TH AVE
Mailing Address - Street 2:SUITE DD
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4241
Mailing Address - Country:US
Mailing Address - Phone:646-719-0309
Mailing Address - Fax:
Practice Address - Street 1:7312 35TH AVE
Practice Address - Street 2:SUITE DD
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4241
Practice Address - Country:US
Practice Address - Phone:646-719-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker