Provider Demographics
NPI:1922521244
Name:COWAN, MONTRELLA (LICSW)
Entity Type:Individual
Prefix:
First Name:MONTRELLA
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2440
Mailing Address - Country:US
Mailing Address - Phone:202-590-2356
Mailing Address - Fax:
Practice Address - Street 1:5028 WISCONSIN AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4118
Practice Address - Country:US
Practice Address - Phone:202-590-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500812251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical