Healthcare Provider Details

I. General information

NPI: 1023040359
Provider Name (Legal Business Name): KATHY A LAWLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD 2ND FLOOR, SOUTH PAVILION
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD 2ND FLOOR, SOUTH PAVILION
PHILADELPHIA PA
19104-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3606
  • Fax:
Mailing address:
  • Phone: 215-662-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS004305L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: