Provider Demographics
NPI:1366492316
Name:COLLURA, LAWRENCE J (MSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:J
Last Name:COLLURA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 ROCKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1408
Mailing Address - Country:US
Mailing Address - Phone:412-221-8106
Mailing Address - Fax:412-319-0708
Practice Address - Street 1:310 ROCKFIELD RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1408
Practice Address - Country:US
Practice Address - Phone:412-221-8106
Practice Address - Fax:412-319-0708
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-000224-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA633825OtherHIGHMARK
PA550534000OtherSELECT BLUE
PA010986OtherCHAMPUS; OPTIONS; TRICARE
PA462181000OtherMAGELLAN EAP
PA4610061OtherAETNA
PA366207OtherCIGNA EAP
PAC9998-0OtherVRI
PA550534000OtherSELECT BLUE