Provider Demographics
NPI:1871227967
Name:LOWE, EVAN ALEX (LMSW)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:ALEX
Last Name:LOWE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 RIVERSIDE DR APT 2
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4328
Mailing Address - Country:US
Mailing Address - Phone:205-887-1313
Mailing Address - Fax:
Practice Address - Street 1:82 RIVERSIDE DR APT 2
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4328
Practice Address - Country:US
Practice Address - Phone:205-887-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106297104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty