Provider Demographics
NPI:1427183409
Name:GONCALVES, LAWRENCE LORENZO JR (LICSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:LORENZO
Last Name:GONCALVES
Suffix:JR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:GONCALVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4301 S PINE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7206
Mailing Address - Country:US
Mailing Address - Phone:253-476-6500
Mailing Address - Fax:
Practice Address - Street 1:4301 S PINE ST STE 301
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7206
Practice Address - Country:US
Practice Address - Phone:253-476-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000097411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC00029532OtherREGISTERED COUNSELOR
WALW00009741OtherLICSW