Provider Demographics
NPI:1962042630
Name:COWAN, MICHAEL E JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:COWAN
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MORNING MIST RD
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-3521
Mailing Address - Country:US
Mailing Address - Phone:203-506-1853
Mailing Address - Fax:
Practice Address - Street 1:56 MORNING MIST RD
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-3521
Practice Address - Country:US
Practice Address - Phone:203-506-1853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT123151041C0700X
CT2778104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker