Provider Demographics
NPI:1730478207
Name:AVITABILE, LAWRENCE ALFRED
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ALFRED
Last Name:AVITABILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2607
Mailing Address - Country:US
Mailing Address - Phone:201-289-7077
Mailing Address - Fax:
Practice Address - Street 1:70 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-2607
Practice Address - Country:US
Practice Address - Phone:201-289-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00081400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional