Provider Demographics
NPI:1982890794
Name:OWENS, JIMMY (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SHIRLEY ST
Mailing Address - Street 2:UNIT C-1
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02746-1150
Mailing Address - Country:US
Mailing Address - Phone:508-993-5113
Mailing Address - Fax:508-984-3389
Practice Address - Street 1:14 SHIRLEY ST
Practice Address - Street 2:UNIT C-1
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02746-1150
Practice Address - Country:US
Practice Address - Phone:508-993-5113
Practice Address - Fax:508-984-3389
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10273721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical