Healthcare Provider Details

I. General information

NPI: 1427183466
Provider Name (Legal Business Name): PAULA VERONICA BOULWARE-BROWN PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 AIRLINE BLVD
PORTSMOUTH VA
23707-3912
US

IV. Provider business mailing address

600H EDEN RD
LANCASTER PA
17601-4205
US

V. Phone/Fax

Practice location:
  • Phone: 757-397-2121
  • Fax: 757-399-3316
Mailing address:
  • Phone: 717-397-1400
  • Fax: 717-509-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003788
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: