Provider Demographics
NPI:1518188556
Name:LAWLOR, MARY R (CPM, LM)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:R
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 WESTERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301
Mailing Address - Country:US
Mailing Address - Phone:802-251-0921
Mailing Address - Fax:802-536-4142
Practice Address - Street 1:229 WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-251-0921
Practice Address - Fax:802-536-4142
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1070000007176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009329Medicaid