Provider Demographics
NPI:1770845901
Name:LAWES, MAYA ANTOINETTE
Entity Type:Individual
Prefix:MISS
First Name:MAYA
Middle Name:ANTOINETTE
Last Name:LAWES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 DUTCH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4244
Mailing Address - Country:US
Mailing Address - Phone:516-661-2919
Mailing Address - Fax:516-792-5374
Practice Address - Street 1:1971 DUTCH BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4244
Practice Address - Country:US
Practice Address - Phone:516-661-2919
Practice Address - Fax:516-792-5374
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst