Basic Information
| Provider Information | |||||||||
| NPI: | 1942958830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAMGBOSE-MARTINS | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 BENJAMIN FRANKLIN PKWY APT S1201 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191303615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015499385 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3535 MARKET ST STE 1230 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191043309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108923800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2022 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PC013033 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.