Provider Demographics
NPI:1629827597
Name:WADWHA, HARSIMRAN KAUR
Entity type:Individual
Prefix:
First Name:HARSIMRAN
Middle Name:KAUR
Last Name:WADWHA
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 1:49-5 REVERE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-5331
Mailing Address - Country:US
Mailing Address - Phone:475-225-7078
Mailing Address - Fax:
Practice Address - Street 1:1952 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-3122
Practice Address - Country:US
Practice Address - Phone:215-291-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1232773101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health