Provider Demographics
NPI:1477223675
Name:PRADER, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PRADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11859 BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-2532
Mailing Address - Country:US
Mailing Address - Phone:215-205-1028
Mailing Address - Fax:
Practice Address - Street 1:281 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-1027
Practice Address - Country:US
Practice Address - Phone:610-234-2913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-18
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health