Provider Demographics
NPI:1619455706
Name:FAWLEY, KARA DEVERS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:DEVERS
Last Name:FAWLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KARA
Other - Middle Name:ANNE
Other - Last Name:DEVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1080 N DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-4330
Mailing Address - Country:US
Mailing Address - Phone:215-688-8707
Mailing Address - Fax:
Practice Address - Street 1:1080 N DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4330
Practice Address - Country:US
Practice Address - Phone:215-688-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018234103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical