Provider Demographics
NPI:1124574983
Name:JOHN LAURITZEN MSW LICSW
Entity Type:Organization
Organization Name:JOHN LAURITZEN MSW LICSW
Other - Org Name:JOHN LAURITZEN HIV CASE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAURITZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LICSW
Authorized Official - Phone:917-880-5894
Mailing Address - Street 1:17 STATE STREET
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1502
Mailing Address - Country:US
Mailing Address - Phone:917-880-5894
Mailing Address - Fax:
Practice Address - Street 1:17 STATE ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1502
Practice Address - Country:US
Practice Address - Phone:917-880-5894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)