Provider Demographics
NPI:1023623915
Name:AVILA, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:AVILA
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 1:2058 MAPLE AVE APT M1-10
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-1452
Mailing Address - Country:US
Mailing Address - Phone:215-353-8931
Mailing Address - Fax:
Practice Address - Street 1:2058 MAPLE AVE APT M1-10
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-1452
Practice Address - Country:US
Practice Address - Phone:215-353-8931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health