MEDICARE: BOW ADULT COUNSELING SERVICES, P.L.L.C.

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1215046818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOW ADULT COUNSELING SERVICES, P.L.L.C.

Provider Business Mailing Address
First Line	:	722 ROUTE 3A
Second Line	:	SUITE 16
City	:	BOW
State	:	NH
Zip	:	03304-4010
Country	:	US
Telephone Number	:	603-230-9444
Fax Number	:	603-228-9990

Provider Business Practice Location Address
First Line	:	722 ROUTE 3A
Second Line	:	SUITE 16
City	:	BOW
State	:	NH
Zip	:	03304-4010
Country	:	US
Telephone Number	:	603-230-9444
Fax Number	:	603-228-9990

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DR. JANET A. LEVENSON
Credential	:	PSY.D.
Telephone Number	:	603-230-9444

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/22/2020

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