Provider Demographics
NPI:1063458123
Name:SALMANSOHN, LAWRENCE H (EDD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:H
Last Name:SALMANSOHN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12893 COCOA PINE DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6144
Mailing Address - Country:US
Mailing Address - Phone:561-638-1932
Mailing Address - Fax:561-638-1932
Practice Address - Street 1:4400 N FEDERAL HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5187
Practice Address - Country:US
Practice Address - Phone:561-638-1932
Practice Address - Fax:561-638-1932
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0004643103G00000X, 103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73848Medicare ID - Type Unspecified