Provider Demographics
NPI:1104805373
Name:LAWLIS, PHILIP J (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:LAWLIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BRAMBLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LEWISBERRY
Mailing Address - State:PA
Mailing Address - Zip Code:17339-9536
Mailing Address - Country:US
Mailing Address - Phone:717-766-4324
Mailing Address - Fax:
Practice Address - Street 1:113 BRAMBLEWOOD LN
Practice Address - Street 2:
Practice Address - City:LEWISBERRY
Practice Address - State:PA
Practice Address - Zip Code:17339-9536
Practice Address - Country:US
Practice Address - Phone:717-766-4324
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004217L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical