Healthcare Provider Details

I. General information

NPI: 1467348839
Provider Name (Legal Business Name): CARA ADDIS LPC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ADAMS AVE STE 100
AUDUBON PA
19403-2404
US

IV. Provider business mailing address

535 HERMITAGE ST
PHILADELPHIA PA
19128-2603
US

V. Phone/Fax

Practice location:
  • Phone: 610-277-3715
  • Fax:
Mailing address:
  • Phone: 724-713-1503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC017256
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: