Provider Demographics
NPI:1083883482
Name:LADDEN, LAWRENCE J (PHD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:LADDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8244 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2404
Mailing Address - Country:US
Mailing Address - Phone:215-561-0341
Mailing Address - Fax:
Practice Address - Street 1:1831 CHESTNUT ST
Practice Address - Street 2:801
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3713
Practice Address - Country:US
Practice Address - Phone:215-561-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005654L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical