Provider Demographics
NPI:1497851299
Name:AVERY, LAWRENCE F (PSYD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:F
Last Name:AVERY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODLAKE RD APT 4
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3973
Mailing Address - Country:US
Mailing Address - Phone:518-452-6891
Mailing Address - Fax:
Practice Address - Street 1:17 WOODLAKE RD APT 4
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3973
Practice Address - Country:US
Practice Address - Phone:518-452-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011855-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical