Provider Demographics
NPI:1629164892
Name:BERLEY, LAWRENCE F (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:F
Last Name:BERLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORDWAINER DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1671
Mailing Address - Country:US
Mailing Address - Phone:781-871-3963
Mailing Address - Fax:
Practice Address - Street 1:200 CORDWAINER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1671
Practice Address - Country:US
Practice Address - Phone:781-871-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA586602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM09525OtherBCBS PROVIDER ID. NUMBER
MAS011999OtherCHAMPUS PROVIDER #
MAM09525OtherBCBS PROVIDER ID. NUMBER