Provider Demographics
NPI:1487193744
Name:HAYWARD, DAMOLLA (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:DAMOLLA
Middle Name:
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 ANDREWS AVE
Mailing Address - Street 2:1ST FL
Mailing Address - City:COLLINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023-3705
Mailing Address - Country:US
Mailing Address - Phone:215-913-2863
Mailing Address - Fax:
Practice Address - Street 1:907 ANDREWS AVE
Practice Address - Street 2:1ST FL
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-3705
Practice Address - Country:US
Practice Address - Phone:215-913-2863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128228104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker