Provider Demographics
NPI:1518168095
Name:MCGOWAN, LAWRENCE P (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:P
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3326
Mailing Address - Country:US
Mailing Address - Phone:718-497-2425
Mailing Address - Fax:718-497-2425
Practice Address - Street 1:6433 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3326
Practice Address - Country:US
Practice Address - Phone:718-497-2425
Practice Address - Fax:718-497-2425
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006700OtherSTATE LICENSE NUMBER