Provider Demographics
NPI:1932287935
Name:COWAN, BERYL ANN (MA,JD)
Entity Type:Individual
Prefix:MS
First Name:BERYL ANN
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:MA,JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 E CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1252
Mailing Address - Country:US
Mailing Address - Phone:678-592-6368
Mailing Address - Fax:
Practice Address - Street 1:20 BOW STREET
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:678-592-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent