Provider Demographics
NPI:1659595486
Name:MERNAUGH, LAWRENCE (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:MERNAUGH
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 CAMPBELL BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5974
Mailing Address - Country:US
Mailing Address - Phone:410-931-9280
Mailing Address - Fax:410-931-6694
Practice Address - Street 1:5024 CAMPBELL BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5974
Practice Address - Country:US
Practice Address - Phone:410-931-9280
Practice Address - Fax:410-931-6694
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health