Provider Demographics
NPI:1073747473
Name:LAWRENCE, ALAN LEON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:LEON
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36840 PALM CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2206
Mailing Address - Country:US
Mailing Address - Phone:760-202-8517
Mailing Address - Fax:
Practice Address - Street 1:160 N LURING DR STE J
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6840
Practice Address - Country:US
Practice Address - Phone:760-250-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 126581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical