Provider Demographics
NPI:1619043429
Name:CABLE, LAWRENCE (EDD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:CABLE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 GLEN ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072
Mailing Address - Country:US
Mailing Address - Phone:781-341-0600
Mailing Address - Fax:781-341-0420
Practice Address - Street 1:27 GLEN ST
Practice Address - Street 2:SUITE 14
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072
Practice Address - Country:US
Practice Address - Phone:781-341-0600
Practice Address - Fax:781-341-0420
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2324103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02527Medicare ID - Type Unspecified