Provider Demographics
NPI:1225564966
Name:CAROL E BOUZOUKIS PHD
Entity Type:Organization
Organization Name:CAROL E BOUZOUKIS PHD
Other - Org Name:PLAY THERAPY DELAWARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPROETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BOUZOUKIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:302-777-1110
Mailing Address - Street 1:4001 KENNETT PIKE
Mailing Address - Street 2:SUITE 244
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2315
Mailing Address - Country:US
Mailing Address - Phone:302-777-1110
Mailing Address - Fax:
Practice Address - Street 1:4001 KENNETT PIKE
Practice Address - Street 2:SUITE 244
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-2315
Practice Address - Country:US
Practice Address - Phone:302-777-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health