Provider Demographics
NPI:1366887051
Name:ROWE, OPAL
Entity type:Individual
Prefix:
First Name:OPAL
Middle Name:
Last Name:ROWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 ROBERT J CONLAN BLVD NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3564
Mailing Address - Country:US
Mailing Address - Phone:321-837-7500
Mailing Address - Fax:321-837-7516
Practice Address - Street 1:1591 ROBERT J CONLAN BLVD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3564
Practice Address - Country:US
Practice Address - Phone:321-837-7500
Practice Address - Fax:321-837-7516
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5257104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker