Provider Demographics
NPI:1184621930
Name:BOWERS, LEE A (PHD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:A
Last Name:BOWERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1214
Mailing Address - Country:US
Mailing Address - Phone:610-520-0443
Mailing Address - Fax:
Practice Address - Street 1:210 TOWER RD
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085
Practice Address - Country:US
Practice Address - Phone:610-520-0443
Practice Address - Fax:610-520-0442
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006234-L103T00000X, 103TH0100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABO 063245OtherBLUE CROSS
PABO 063245OtherBLUE CROSS