Provider Demographics
NPI:1043244171
Name:VANHEUSEN, LAWRENCE LEWIS (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:LEWIS
Last Name:VANHEUSEN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 COLVIN AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2452
Mailing Address - Country:US
Mailing Address - Phone:716-875-3771
Mailing Address - Fax:
Practice Address - Street 1:JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY
Practice Address - Street 2:70 BARKER ST.
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2013
Practice Address - Country:US
Practice Address - Phone:716-883-1914
Practice Address - Fax:716-883-7637
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0417691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000524961002OtherBLUE CROSS OF WNY
NY00688211Medicaid
NY000524961002OtherBLUE CROSS OF WNY