Provider Demographics
NPI:1083243547
Name:LAWRENCE, EVAN (LMHC)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BROADWAY FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1744
Mailing Address - Country:US
Mailing Address - Phone:347-560-0642
Mailing Address - Fax:
Practice Address - Street 1:115 BROADWAY FL 17
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1604
Practice Address - Country:US
Practice Address - Phone:347-560-0642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health