Provider Demographics
NPI:1316588205
Name:LAWSON, GWENDOLYN M (PHD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:M
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1526
Mailing Address - Country:US
Mailing Address - Phone:402-301-1245
Mailing Address - Fax:
Practice Address - Street 1:2716 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-2305
Practice Address - Country:US
Practice Address - Phone:402-301-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018894103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist