Provider Demographics
NPI:1467590430
Name:VENDITTO, LAWRENCE THOMAS (MSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:THOMAS
Last Name:VENDITTO
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 1:2811 E. MADISON
Mailing Address - Street 2:205
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112
Mailing Address - Country:US
Mailing Address - Phone:206-568-2674
Mailing Address - Fax:206-324-5565
Practice Address - Street 1:2811 E. MADISON
Practice Address - Street 2:205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112
Practice Address - Country:US
Practice Address - Phone:206-568-2674
Practice Address - Fax:206-324-5565
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2070CP2414101YA0400X
WA20704LW43091041C0700X
WA20705LF930106H00000X
WA20704-LW43091041C0700X
WA20705-LF930106H00000X
WA20706-CP2414101YA0400X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R30178Medicare UPIN
G000120238Medicare PIN
000120238Medicare ID - Type Unspecified