Provider Demographics
NPI:1235379132
Name:LENNON, LAWRENCE B (PHD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:B
Last Name:LENNON
Suffix:
Gender:M
Credentials:PHD
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 501
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-0501
Mailing Address - Country:US
Mailing Address - Phone:317-575-9645
Mailing Address - Fax:317-575-9653
Practice Address - Street 1:2633 E 136TH ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1855
Practice Address - Country:US
Practice Address - Phone:317-575-9645
Practice Address - Fax:317-575-9653
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010358A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical