Provider Demographics
NPI:1114913720
Name:LAWRENCE, JEFFREY R (MSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:R
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 CENTRAL AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1204
Mailing Address - Country:US
Mailing Address - Phone:516-374-1360
Mailing Address - Fax:516-536-0313
Practice Address - Street 1:949 CENTRAL AVE
Practice Address - Street 2:STE 200
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1204
Practice Address - Country:US
Practice Address - Phone:516-374-1360
Practice Address - Fax:516-536-0313
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR007430-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR007430OtherHIP PROVIDER #
NY0054754OtherGHI PROVIDER#
NYR007430OtherHIP PROVIDER #