Provider Demographics
NPI:1326421843
Name:JENNINGS, LAWRENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:JENNINGS
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 1:20 BRANDY WINE XING
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06783-1220
Mailing Address - Country:US
Mailing Address - Phone:860-350-0945
Mailing Address - Fax:
Practice Address - Street 1:20 BRANDY WINE XING
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:CT
Practice Address - Zip Code:06783-1220
Practice Address - Country:US
Practice Address - Phone:860-350-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009803103TC0700X
CT001583103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical