Provider Demographics
NPI:1679790463
Name:LAWRENCE, EUGENE F SR (MED, CADC, LADC 1)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:F
Last Name:LAWRENCE
Suffix:SR
Gender:M
Credentials:MED, CADC, LADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-3009
Mailing Address - Country:US
Mailing Address - Phone:617-889-8779
Mailing Address - Fax:
Practice Address - Street 1:175 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3009
Practice Address - Country:US
Practice Address - Phone:617-889-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1965101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty