MEDICARE: LAURA HAWLEY L.AC., LCSW

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	171100000X	Acupuncturist	AK000402L	PA
2	1041C0700X	Clinical Social Worker	CW019236	PA

General Provider Information

NPI Number	:	1972688422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA HAWLEY L.AC., LCSW

Provider Business Mailing Address
First Line	:	255 S 17TH ST STE 1503
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19103-6215
Country	:	US
Telephone Number	:	215-545-7040
Fax Number	:	215-545-4095

Provider Business Practice Location Address
First Line	:	255 S 17TH ST STE 1502
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19103-6215
Country	:	US
Telephone Number	:	215-545-7040
Fax Number	:	215-545-4095

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	10/05/2017

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