Provider Demographics
NPI:1740316322
Name:BOWEN, TANYA S (PHD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:S
Last Name:BOWEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2206
Mailing Address - Country:US
Mailing Address - Phone:315-420-7065
Mailing Address - Fax:
Practice Address - Street 1:530 OAK ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1652
Practice Address - Country:US
Practice Address - Phone:315-420-7065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013149103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical