Provider Demographics
NPI:1033442710
Name:LAWRENCE, BROOKS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:BROOKS
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W 63RD ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7157
Mailing Address - Country:US
Mailing Address - Phone:617-365-7441
Mailing Address - Fax:
Practice Address - Street 1:33 W 63RD ST APT 3B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7157
Practice Address - Country:US
Practice Address - Phone:617-365-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019100235Z00000X
MA4929235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist