Provider Demographics
NPI:1073638375
Name:LAWRENCE, MYRA MACKOFF (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:MACKOFF
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HARGER RD
Mailing Address - Street 2:SUITE # 505
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1805
Mailing Address - Country:US
Mailing Address - Phone:630-571-1110
Mailing Address - Fax:630-571-5751
Practice Address - Street 1:1200 HARGER RD
Practice Address - Street 2:SUITE # 505
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1805
Practice Address - Country:US
Practice Address - Phone:630-571-1110
Practice Address - Fax:630-571-5751
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist