Provider Demographics
NPI:1689767220
Name:NOWELL, KRISTIN LYNNE (MA)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LYNNE
Last Name:NOWELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:280 N PROVIDENCE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3527
Mailing Address - Country:US
Mailing Address - Phone:610-996-0057
Mailing Address - Fax:610-566-0502
Practice Address - Street 1:280 N PROVIDENCE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3527
Practice Address - Country:US
Practice Address - Phone:610-566-0501
Practice Address - Fax:610-566-0502
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008074L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical