Nicole Mowbray, PSY.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS019273 Issued in PA

Practice address

6 Newberry CT
Glen Mills, PA 19342-9524

Phone

(610) 764-7899

NPI assigned

Aug 2, 2021

Last updated

Aug 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 8, 2022 through Dec 8, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627862400000",
    "number": "1356015515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 NEWBERRY CT",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "193429524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 NEWBERRY CT",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "193429524",
            "telephone_number": "610-764-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOWBRAY",
        "first_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-02",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS019273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PS019273",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.theimagroup.com",
            "affiliation": "N",
            "address_1": "6 Newberry Ct",
            "city": "Glen Mills",
            "state": "PA",
            "country_code": "US",
            "postal_code": "193429524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ann E Moore, CRNP
• Jane Ruth Moore, OTRL CHT
• Joel G Moranz, MD
• Jasoni Lee Morgan, CRNP
• Christie O Mousaw, DO
• Chantel Priolo Mozal, MPH, PA-C
• Grace Mulcahy
• Kelly Mullan
• Denise A Mulvaney, MD
• Brian J Murphy, DO

• Psychologist in Glen Mills, PA
• Providers in Glen Mills, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.