Provider Demographics
NPI:1134325244
Name:DARIENZO, LAWRENCE ALAN (MA)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ALAN
Last Name:DARIENZO
Suffix:
Gender:M
Credentials:MA
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 645
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98235
Mailing Address - Country:US
Mailing Address - Phone:360-856-0973
Mailing Address - Fax:
Practice Address - Street 1:27877 W GILLIGAN CRK RD
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284
Practice Address - Country:US
Practice Address - Phone:360-856-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005464101YM0800X
WALF00001517106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist