Provider Demographics
NPI:1548295652
Name:BOWERS, CAROLYN S (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:BOWERS
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 1:2809 W GODMAN AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4477
Mailing Address - Country:US
Mailing Address - Phone:765-281-1300
Mailing Address - Fax:765-281-8823
Practice Address - Street 1:2809 W GODMAN AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4477
Practice Address - Country:US
Practice Address - Phone:765-281-1300
Practice Address - Fax:765-281-8823
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340049471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000373277OtherANTHEM PIN NUMBER