Provider Demographics
NPI:1790825891
Name:ROWAN, RICHARD A (MA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:ROWAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 454
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-9516
Mailing Address - Country:US
Mailing Address - Phone:724-224-3302
Mailing Address - Fax:
Practice Address - Street 1:1575 DONNELLVILLE RD
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-3001
Practice Address - Country:US
Practice Address - Phone:724-224-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007172-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015288450001OtherMA NUMBER