Provider Demographics
NPI:1669086674
Name:FOWLER, NADINE KATHLEEN (LMHC)
Entity type:Individual
Prefix:MS
First Name:NADINE
Middle Name:KATHLEEN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:NADINE
Other - Middle Name:KATHLEEN
Other - Last Name:RAVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:30 S WASHINGTON ST UNIT 72
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02761-7704
Mailing Address - Country:US
Mailing Address - Phone:774-225-0851
Mailing Address - Fax:
Practice Address - Street 1:30 S WASHINGTON ST UNIT 72
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02761-7704
Practice Address - Country:US
Practice Address - Phone:774-225-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health