Provider Demographics
NPI:1548524846
Name:OWEN, SIAN E (MA)
Entity type:Individual
Prefix:MS
First Name:SIAN
Middle Name:E
Last Name:OWEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 470675
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE VILLAGE
Mailing Address - State:MA
Mailing Address - Zip Code:02447-0675
Mailing Address - Country:US
Mailing Address - Phone:617-383-4641
Mailing Address - Fax:
Practice Address - Street 1:320 WASHINGTON ST STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6873
Practice Address - Country:US
Practice Address - Phone:617-383-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1052101YM0800X
MA9117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE2534Medicare PIN