Basic Information
| Provider Information | |||||||||
| NPI: | 1376713396 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COWIE | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 323 | ||||||||
| Address2: | |||||||||
| City: | BRANT ROCK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020200323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817044915 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Practice Location | |||||||||
| Address1: | 439 COLUMBIA RD STE 205 | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023392393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817044915 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2008 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1020767 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.