Provider Demographics
NPI:1235292079
Name:HANELLY, LAWRENCE DAVID (LPC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:DAVID
Last Name:HANELLY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 EAST FIFTH STREET
Mailing Address - Street 2:
Mailing Address - City:BELLWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:16617-2015
Mailing Address - Country:US
Mailing Address - Phone:814-742-1216
Mailing Address - Fax:814-949-9345
Practice Address - Street 1:809 ROUTE 764
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635
Practice Address - Country:US
Practice Address - Phone:814-215-3766
Practice Address - Fax:814-949-9345
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALPC000280101YA0400X, 101YM0800X
PAPC000280101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0105602Medicaid
PA0105602Medicaid