Provider Demographics
NPI:1518332543
Name:HAWORTH, THOMAS FREDRICK (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FREDRICK
Last Name:HAWORTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SOUTH BROAD ST
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110
Mailing Address - Country:US
Mailing Address - Phone:609-970-3345
Mailing Address - Fax:215-701-1575
Practice Address - Street 1:100 SOUTH BROAD ST
Practice Address - Street 2:SUITE 1700
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110
Practice Address - Country:US
Practice Address - Phone:609-970-3345
Practice Address - Fax:215-701-1575
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical