Provider Demographics
NPI:1932666245
Name:BOWEN, SAMANTHA JOSEPHINE (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOSEPHINE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-9164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1965 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-9164
Practice Address - Country:US
Practice Address - Phone:717-870-4662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0195481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty