MEDICARE: DR. LEE A. BOWERS PH.D.

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	103T00000X	Psychologist	PS-006234-L	PA
2	103TH0100X	Health Service Psychologist	PS-006234-L	PA
3	103TC0700X	Clinical Psychologist	PS-006234-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BO 063245	OTHER	PA	BLUE CROSS

General Provider Information

NPI Number	:	1184621930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE A. BOWERS PH.D.

Provider Business Mailing Address
First Line	:	210 TOWER RD
Second Line	:
City	:	VILLANOVA
State	:	PA
Zip	:	19085-1214
Country	:	US
Telephone Number	:	610-520-0443
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 TOWER RD
Second Line	:
City	:	VILLANOVA
State	:	PA
Zip	:	19085
Country	:	US
Telephone Number	:	610-520-0443
Fax Number	:	610-520-0442

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/09/2018

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Directions to “ DR. LEE A. BOWERS PH.D.” Practice Location

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