Provider Demographics
NPI:1689768871
Name:LAWRENZ, MARK DAVID (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:LAWRENZ
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 1:4112 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-1738
Mailing Address - Country:US
Mailing Address - Phone:562-221-9069
Mailing Address - Fax:
Practice Address - Street 1:211 W COMMONWEALTH AVE STE 204
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1810
Practice Address - Country:US
Practice Address - Phone:714-447-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS219411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical