Provider Demographics
NPI:1437211471
Name:KEATING, LAWRENCE
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:KEATING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LAWRENCE AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3619
Mailing Address - Country:US
Mailing Address - Phone:631-360-2223
Mailing Address - Fax:631-360-2288
Practice Address - Street 1:22 LAWRENCE AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3619
Practice Address - Country:US
Practice Address - Phone:631-360-2223
Practice Address - Fax:631-360-2288
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041337-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02553437Medicaid
NYN9L631Medicare ID - Type Unspecified
NY02553437Medicaid