Provider Demographics
NPI:1114139557
Name:RAIFMAN, LAWRENCE J (PHD, J D)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:RAIFMAN
Suffix:
Gender:M
Credentials:PHD, J D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11005 VALLEY HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3056
Mailing Address - Country:US
Mailing Address - Phone:410-998-9245
Mailing Address - Fax:410-998-9250
Practice Address - Street 1:1501 SULGRAVE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3654
Practice Address - Country:US
Practice Address - Phone:410-998-9245
Practice Address - Fax:410-998-9250
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1757103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical