Provider Demographics
NPI:1407596638
Name:HARLEY, DEJAH MONAE (MA)
Entity Type:Individual
Prefix:
First Name:DEJAH
Middle Name:MONAE
Last Name:HARLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CHERRY ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2061
Mailing Address - Country:US
Mailing Address - Phone:215-847-6749
Mailing Address - Fax:
Practice Address - Street 1:325 CHERRY ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2061
Practice Address - Country:US
Practice Address - Phone:215-847-6749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health