Provider Demographics
NPI:1609176650
Name:BOUSQUET, MEGAN E (MA, ATR, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:E
Last Name:BOUSQUET
Suffix:
Gender:F
Credentials:MA, ATR, LPC
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:956 N AMERICAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-2230
Mailing Address - Country:US
Mailing Address - Phone:609-790-1716
Mailing Address - Fax:
Practice Address - Street 1:737 N 4TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2907
Practice Address - Country:US
Practice Address - Phone:215-436-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14101101YP2500X
PAPC008464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional