Healthcare Provider Details

I. General information

NPI: 1487784740
Provider Name (Legal Business Name): KATE K. CORNWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W LANCASTER AVE SECOND FLOOR
BRYN MAWR PA
19010-3224
US

IV. Provider business mailing address

115 WYNNEDALE RD
NARBERTH PA
19072-1726
US

V. Phone/Fax

Practice location:
  • Phone: 610-520-1510
  • Fax:
Mailing address:
  • Phone: 610-520-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCW012433
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: