Provider Demographics
NPI:1972688422
Name:HAWLEY, LAURA (LAC, LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:LAC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST STE 1503
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6215
Mailing Address - Country:US
Mailing Address - Phone:215-545-7040
Mailing Address - Fax:215-545-4095
Practice Address - Street 1:255 S 17TH ST STE 1502
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19103-6215
Practice Address - Country:US
Practice Address - Phone:215-545-7040
Practice Address - Fax:215-545-4095
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000402L171100000X
PACW0192361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171100000XOther Service ProvidersAcupuncturist