Provider Demographics
NPI:1487024022
Name:BRACY, LAWRENCE JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:BRACY
Suffix:JR
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 1:3275 MORRELL AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1117
Mailing Address - Country:US
Mailing Address - Phone:267-333-5280
Mailing Address - Fax:
Practice Address - Street 1:3275 MORRELL AVE FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1117
Practice Address - Country:US
Practice Address - Phone:267-333-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst