Provider Demographics
NPI:1871309054
Name:DOE, HAWA
Entity type:Individual
Prefix:
First Name:HAWA
Middle Name:
Last Name:DOE
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 1:1002 KEDRON AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-1623
Mailing Address - Country:US
Mailing Address - Phone:267-348-7459
Mailing Address - Fax:
Practice Address - Street 1:1023 E BALTIMORE PIKE STE 303
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5126
Practice Address - Country:US
Practice Address - Phone:610-449-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006775103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst