Provider Demographics
NPI:1669086674
Name:FOWLER, NADINE KATHLEEN (LMHC)
Entity type:Individual
Prefix:MS
First Name:NADINE
Middle Name:KATHLEEN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:NADINE
Other - Middle Name:KATHLEEN
Other - Last Name:RAVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:42 LEONARD ST APT 201
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1128
Mailing Address - Country:US
Mailing Address - Phone:617-901-9325
Mailing Address - Fax:
Practice Address - Street 1:42 LEONARD ST APT 201
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1128
Practice Address - Country:US
Practice Address - Phone:617-901-9325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health