Provider Demographics
NPI:1659003689
Name:LAWRENCE, DONNA (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 COMMONWEALTH AVE # PH
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-3504
Mailing Address - Country:US
Mailing Address - Phone:917-575-9542
Mailing Address - Fax:
Practice Address - Street 1:610 COMMONWEALTH AVE # PH
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-3504
Practice Address - Country:US
Practice Address - Phone:917-575-9542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106730-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker