Provider Demographics
NPI:1629548698
Name:LAWRENCE, KEITHIE PEIRRE (CASAC)
Entity Type:Individual
Prefix:MR
First Name:KEITHIE
Middle Name:PEIRRE
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:MR
Other - First Name:KEITHIE
Other - Middle Name:P
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC
Mailing Address - Street 1:1371 LINDEN BLVD APT 7D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-4710
Mailing Address - Country:US
Mailing Address - Phone:646-305-2676
Mailing Address - Fax:
Practice Address - Street 1:1371 LINDEN BLVD APT 7D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4710
Practice Address - Country:US
Practice Address - Phone:646-305-2676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25659101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor