Provider Demographics
NPI:1891707865
Name:FOWLER, AMY L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 KING ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2335
Mailing Address - Country:US
Mailing Address - Phone:413-582-3908
Mailing Address - Fax:413-584-1792
Practice Address - Street 1:241 KING ST
Practice Address - Street 2:SUITE 218
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2335
Practice Address - Country:US
Practice Address - Phone:413-582-3908
Practice Address - Fax:413-584-1792
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAFOW51081Medicare ID - Type Unspecified