Provider Demographics
NPI:1437739588
Name:BOVA, MARIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:BOVA
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 1:2417 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-7318
Mailing Address - Country:US
Mailing Address - Phone:717-439-4914
Mailing Address - Fax:
Practice Address - Street 1:2417 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7318
Practice Address - Country:US
Practice Address - Phone:717-439-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical