Healthcare Provider Details

I. General information

NPI: 1174881841
Provider Name (Legal Business Name): LAVERNE HOFFLER-DUCKWORTH SW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 SENTRY PKWY E BLDG 5
BLUE BELL PA
19422-2312
US

IV. Provider business mailing address

600 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1800
US

V. Phone/Fax

Practice location:
  • Phone: 267-481-5889
  • Fax:
Mailing address:
  • Phone: 267-781-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPCO10820
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010820
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: