Healthcare Provider Details

I. General information

NPI: 1518332543
Provider Name (Legal Business Name): THOMAS FREDRICK HAWORTH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH BROAD ST SUITE 1700
PHILADELPHIA PA
19110
US

IV. Provider business mailing address

100 SOUTH BROAD ST SUITE 1700
PHILADELPHIA PA
19110
US

V. Phone/Fax

Practice location:
  • Phone: 609-970-3345
  • Fax: 215-701-1575
Mailing address:
  • Phone: 609-970-3345
  • Fax: 215-701-1575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS015277
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: