Provider Demographics
NPI:1538167515
Name:GOWER, REGINA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:M
Last Name:GOWER
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 1:501 GOODLETTE RD N
Mailing Address - Street 2:D 100
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5661
Mailing Address - Country:US
Mailing Address - Phone:239-994-0003
Mailing Address - Fax:239-659-1313
Practice Address - Street 1:501 GOODLETTE RD N
Practice Address - Street 2:D 100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5661
Practice Address - Country:US
Practice Address - Phone:239-994-0003
Practice Address - Fax:239-659-1313
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW3808OtherSTATE LICENSE
FL7673205 00Medicaid
FLZ7444Medicare ID - Type Unspecified