Provider Demographics
NPI:1487998894
Name:BOWMAN, IRENE G
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:G
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MONTGOMERY AVE
Mailing Address - Street 2:#107
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3044
Mailing Address - Country:US
Mailing Address - Phone:610-613-8959
Mailing Address - Fax:
Practice Address - Street 1:930 MONTGOMERY AVE
Practice Address - Street 2:#107
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3044
Practice Address - Country:US
Practice Address - Phone:610-613-8959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017273103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist