Provider Demographics
NPI:1912223595
Name:KATHLEEN A BOWEN NP OF PSYCHIATRY PC.
Entity Type:Organization
Organization Name:KATHLEEN A BOWEN NP OF PSYCHIATRY PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSEPRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:631-689-5390
Mailing Address - Street 1:28 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1347
Mailing Address - Country:US
Mailing Address - Phone:631-689-5390
Mailing Address - Fax:631-689-5395
Practice Address - Street 1:28 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1347
Practice Address - Country:US
Practice Address - Phone:631-689-5390
Practice Address - Fax:631-689-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401202-1103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty