Healthcare Provider Details

I. General information

NPI: 1497310502
Provider Name (Legal Business Name): IFRAJ IBRAHIM-ALLEN KERR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OLD WEST CHESTER PIKE
HAVERTOWN PA
19083-2712
US

IV. Provider business mailing address

333 LANCASTER AVE APT 721
MALVERN PA
19355-1828
US

V. Phone/Fax

Practice location:
  • Phone: 484-454-8700
  • Fax:
Mailing address:
  • Phone: 215-313-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC011258
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: