Provider Demographics
NPI:1205395993
Name:LAURNCE SCHULMAN
Entity Type:Organization
Organization Name:LAURNCE SCHULMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULMAN
Authorized Official - Suffix:I
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-607-7773
Mailing Address - Street 1:1601 OCEAN DR S APT 1001
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6343
Mailing Address - Country:US
Mailing Address - Phone:904-607-7773
Mailing Address - Fax:
Practice Address - Street 1:100 CORRIDOR RD STE 250
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-8218
Practice Address - Country:US
Practice Address - Phone:904-607-7773
Practice Address - Fax:904-853-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty