Provider Demographics
NPI:1437175304
Name:BOWMAN, CHARISSE REGENE (LCSW)
Entity type:Individual
Prefix:
First Name:CHARISSE
Middle Name:REGENE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHARISSE
Other - Middle Name:REGENE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:342 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-1247
Mailing Address - Country:US
Mailing Address - Phone:724-469-2171
Mailing Address - Fax:
Practice Address - Street 1:1 INTERMEDIATE UNIT DR
Practice Address - Street 2:
Practice Address - City:COAL CENTER
Practice Address - State:PA
Practice Address - Zip Code:15423-1000
Practice Address - Country:US
Practice Address - Phone:724-938-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0248341041C0700X
PASW123374104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical