Provider Demographics
NPI:1972536449
Name:BOWEN, MARTHA HILL (LICSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:HILL
Last Name:BOWEN
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 1:128 MERCHANTS ROW
Mailing Address - Street 2:STE 604
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-5912
Mailing Address - Country:US
Mailing Address - Phone:802-773-1411
Mailing Address - Fax:802-773-9811
Practice Address - Street 1:128 MERCHANTS ROW
Practice Address - Street 2:STE 604
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5912
Practice Address - Country:US
Practice Address - Phone:802-773-1411
Practice Address - Fax:802-773-9811
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900002741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0553Medicaid
VTOVN0553Medicaid