MEDICARE: LAWRENCE J LADDEN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS005654L	PA

General Provider Information

NPI Number	:	1083883482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE J LADDEN PHD

Provider Business Mailing Address
First Line	:	8244 BROOKSIDE RD
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-2404
Country	:	US
Telephone Number	:	215-561-0341
Fax Number	:

Provider Business Practice Location Address
First Line	:	1831 CHESTNUT ST
Second Line	:	801
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-3713
Country	:	US
Telephone Number	:	215-561-0341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	02/29/2008

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