Basic Information
Provider Information
NPI: 1366841470
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROWLEY
FirstName: JOANNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PMHCNS-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 OCEAN AVE
Address2: WELLNESS 5TH FLR
City: REVERE
State: MA
PostalCode: 021513675
CountryCode: US
TelephoneNumber: 9784656064
FaxNumber: 7814856230
Practice Location
Address1: 300 OCEAN AVE
Address2: WELLNESS 5TH FLR
City: REVERE
State: MA
PostalCode: 021513675
CountryCode: US
TelephoneNumber: 9784656064
FaxNumber: 7814856230
Other Information
ProviderEnumerationDate: 08/14/2014
LastUpdateDate: 08/14/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WP0809XRN170264MAY Nursing Service ProvidersRegistered NursePsych/Mental Health, Adult

No ID Information.


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