Basic Information
| Provider Information | |||||||||
| NPI: | 1568854479 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE CENTERED LIFE PROJECT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 IVY LN | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194064417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106593763 | ||||||||
| FaxNumber: | 6108789331 | ||||||||
| Practice Location | |||||||||
| Address1: | 133 IVY LN | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194064417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106593763 | ||||||||
| FaxNumber: | 6108789331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2015 | ||||||||
| LastUpdateDate: | 03/02/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BOWARD | ||||||||
| AuthorizedOfficialFirstName: | KRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6106593763 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | PS015415 | PA | Y | Agencies | Community/Behavioral Health |
No ID Information.