Provider Demographics
NPI:1285157172
Name:NOWAK, JENNIFER REBEKAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:REBEKAH
Last Name:NOWAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SHELTON LN
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1190
Mailing Address - Country:US
Mailing Address - Phone:215-266-0816
Mailing Address - Fax:
Practice Address - Street 1:4 TERRY DR STE 17
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1838
Practice Address - Country:US
Practice Address - Phone:267-980-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical