MEDICARE: MS. TRINA M DOW ATR, BC,LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC002867	PA

General Provider Information

NPI Number	:	1073644258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRINA M DOW ATR, BC,LPC

Provider Business Mailing Address
First Line	:	4917 CATHARINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-2007
Country	:	US
Telephone Number	:	215-748-0482
Fax Number	:	215-662-8887

Provider Business Practice Location Address
First Line	:	3910 POWELTON AVE
Second Line	:	3RD FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4621
Country	:	US
Telephone Number	:	215-662-8881
Fax Number	:	215-662-8887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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