Provider Demographics
NPI:1912366089
Name:BOWSER, TARA L (MSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:BOWSER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 W 139TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1508
Mailing Address - Country:US
Mailing Address - Phone:212-690-7234
Mailing Address - Fax:212-690-0969
Practice Address - Street 1:34 W 139TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1508
Practice Address - Country:US
Practice Address - Phone:212-690-7234
Practice Address - Fax:212-690-0969
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP00611104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker