Provider Demographics
NPI:1013949734
Name:BOWLES, SHELLEY CARMINE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:CARMINE
Last Name:BOWLES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5728 MAJOR BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7945
Mailing Address - Country:US
Mailing Address - Phone:407-325-5719
Mailing Address - Fax:407-532-4971
Practice Address - Street 1:5728 MAJOR BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7945
Practice Address - Country:US
Practice Address - Phone:407-325-5719
Practice Address - Fax:407-532-4971
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW50661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL763049200Medicaid
FLZ0540Medicare ID - Type UnspecifiedLCSW