Provider Demographics
NPI:1003323593
Name:LAWLESS, JULIE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:LAWLESS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3963 COUNTY ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:MADRID
Mailing Address - State:NY
Mailing Address - Zip Code:13660-3189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 LEROY ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1786
Practice Address - Country:US
Practice Address - Phone:315-265-3300
Practice Address - Fax:315-261-5422
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082118-1104100000X
NY847301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker