Provider Demographics
NPI:1699963900
Name:SUBURBAN PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:SUBURBAN PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-520-0443
Mailing Address - Street 1:PO BOX 7055
Mailing Address - Street 2:
Mailing Address - City:SAINT DAVIDS
Mailing Address - State:PA
Mailing Address - Zip Code:19087-7055
Mailing Address - Country:US
Mailing Address - Phone:610-520-0443
Mailing Address - Fax:315-285-1598
Practice Address - Street 1:210 TOWER RD
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1214
Practice Address - Country:US
Practice Address - Phone:610-520-0443
Practice Address - Fax:315-285-1598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006234-L261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)