Provider Demographics
NPI:1740846401
Name:BOWLES, MARTHA ANGELA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ANGELA
Last Name:BOWLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 MCCREA DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-3587
Mailing Address - Country:US
Mailing Address - Phone:813-610-2798
Mailing Address - Fax:
Practice Address - Street 1:4210 W BAY VILLA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1206
Practice Address - Country:US
Practice Address - Phone:813-837-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW162961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical