Provider Demographics
NPI:1427183466
Name:BOULWARE-BROWN, PAULA VERONICA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:VERONICA
Last Name:BOULWARE-BROWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600H EDEN RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4205
Mailing Address - Country:US
Mailing Address - Phone:717-397-1400
Mailing Address - Fax:717-509-4066
Practice Address - Street 1:1805 AIRLINE BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3912
Practice Address - Country:US
Practice Address - Phone:757-397-2121
Practice Address - Fax:757-399-3316
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical