Provider Demographics
NPI:1184171019
Name:KRISTIN BOWLES & ASSOCIATES, LLC
Entity type:Organization
Organization Name:KRISTIN BOWLES & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:617-763-8091
Mailing Address - Street 1:105 EASTERN AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4555
Mailing Address - Country:US
Mailing Address - Phone:617-763-8091
Mailing Address - Fax:617-686-9681
Practice Address - Street 1:105 EASTERN AVE STE 207
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4555
Practice Address - Country:US
Practice Address - Phone:617-763-8091
Practice Address - Fax:617-686-9681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1170971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty