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Martí Flowers, Ed. D., LCSW, LEFT, E.T.(P/A/M), E.I.S.S 15 Fishers Road, Suite 214 Pitts ford, NY, 14534 (585) 3300472 PATIENT CONTRACT MY PRACTICE includes psychotherapy for children, youth, adults,
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Marti C. Fausold-Mowers, LCSW-R, is a licensed clinical social worker who is authorized to provide mental health services and therapy.
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To fill out the form, complete all required sections with accurate personal and professional information, and provide necessary documentation as specified in the guidelines.
The purpose of the marti c fausold-mowers lcsw-r is to ensure compliance with state regulations for practicing social work and to facilitate professional certification.
Relevant personal details, professional qualifications, hours of supervised experience, and records of continuing education must be reported on the form.
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