Provider Demographics
NPI:1831130228
Name:BOWMAN, PHYLLIS RUTH (EDD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:RUTH
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PLYMPTON RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1803
Mailing Address - Country:US
Mailing Address - Phone:978-256-2250
Mailing Address - Fax:
Practice Address - Street 1:9 ACTON RD
Practice Address - Street 2:SUTIE 24
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3498
Practice Address - Country:US
Practice Address - Phone:978-256-2250
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1103103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0513695Medicaid
MAW01039Medicare ID - Type UnspecifiedPSYCHOLOGIST