Provider Demographics
NPI:1093910721
Name:LAWRENCE, ALBERT EDWARD III (MED, LMHC, NCC)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:EDWARD
Last Name:LAWRENCE
Suffix:III
Gender:M
Credentials:MED, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2262
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-0965
Mailing Address - Country:US
Mailing Address - Phone:774-644-1622
Mailing Address - Fax:781-341-7272
Practice Address - Street 1:3 PORTER ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2978
Practice Address - Country:US
Practice Address - Phone:781-708-4504
Practice Address - Fax:781-341-7272
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7518101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health