Provider Demographics
NPI:1689748857
Name:IANNOTTI, LAWRENCE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:IANNOTTI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 AVENUE OF THE AMERICAS RM 1705
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3507
Mailing Address - Country:US
Mailing Address - Phone:212-465-1917
Mailing Address - Fax:
Practice Address - Street 1:875 AVENUE OF THE AMERICAS RM 1705
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3507
Practice Address - Country:US
Practice Address - Phone:212-465-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0480061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR048006OtherLICENSE
NYNE3731Medicare ID - Type Unspecified