Provider Demographics
NPI:1831532993
Name:BOWMAN, SUZANNE (LICSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 IMPERIAL PL UNIT 5B
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4643
Mailing Address - Country:US
Mailing Address - Phone:401-751-6080
Mailing Address - Fax:401-751-6080
Practice Address - Street 1:18 IMPERIAL PL
Practice Address - Street 2:UNIT 5B
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4641
Practice Address - Country:US
Practice Address - Phone:401-751-6080
Practice Address - Fax:401-751-6080
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW002041041C0700X
MA1069101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical