Provider Demographics
NPI:1124380191
Name:LAWLESS, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:LAWLESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1699
Mailing Address - Country:US
Mailing Address - Phone:315-445-4010
Mailing Address - Fax:315-445-4060
Practice Address - Street 1:3049 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1699
Practice Address - Country:US
Practice Address - Phone:315-445-4010
Practice Address - Fax:315-445-4060
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist