Provider Demographics
NPI:1396931713
Name:SIMONETTI COWGILL, MARY (MA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SIMONETTI COWGILL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 BETHLEHEM PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-9710
Mailing Address - Country:US
Mailing Address - Phone:215-257-3643
Mailing Address - Fax:215-257-3643
Practice Address - Street 1:595 BETHLEHEM PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9710
Practice Address - Country:US
Practice Address - Phone:215-257-3643
Practice Address - Fax:215-257-3643
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005070-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical