Provider Demographics
NPI:1104330216
Name:BOWERSOX, DONALD FREDERIC (LMSW)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:FREDERIC
Last Name:BOWERSOX
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 HARRY L DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1036
Mailing Address - Country:US
Mailing Address - Phone:607-729-7777
Mailing Address - Fax:607-729-7779
Practice Address - Street 1:780 HARRY L DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1036
Practice Address - Country:US
Practice Address - Phone:607-729-7777
Practice Address - Fax:607-729-7779
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101483-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker