Provider Demographics
NPI:1811244429
Name:FOWLE, LAUREN ALEXIS
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALEXIS
Last Name:FOWLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 TRINITY AVE
Mailing Address - Street 2:APT E9
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3007
Mailing Address - Country:US
Mailing Address - Phone:646-623-7599
Mailing Address - Fax:
Practice Address - Street 1:1967 TURNBULL AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2519
Practice Address - Country:US
Practice Address - Phone:718-842-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool