Provider Demographics
NPI:1093532335
Name:COWELL, NASTASSIA JADINE
Entity type:Individual
Prefix:
First Name:NASTASSIA
Middle Name:JADINE
Last Name:COWELL
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 1:1233 RHAWN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2637
Mailing Address - Country:US
Mailing Address - Phone:267-579-6330
Mailing Address - Fax:
Practice Address - Street 1:1233 RHAWN ST APT 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2637
Practice Address - Country:US
Practice Address - Phone:267-579-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician