Provider Demographics
NPI:1376124263
Name:LAWRENCE, DONALD (BS NBC-HIS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:BS NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 E MAIN ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2647
Mailing Address - Country:US
Mailing Address - Phone:845-343-7708
Mailing Address - Fax:845-343-7712
Practice Address - Street 1:28 RAILROAD AVE STE 1C
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1643
Practice Address - Country:US
Practice Address - Phone:845-986-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000024143237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist