Provider Demographics
NPI:1790961605
Name:WHITING, LAWRENCE E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:E
Last Name:WHITING
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 1:1560 KINGSLEY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4593
Mailing Address - Country:US
Mailing Address - Phone:904-621-0656
Mailing Address - Fax:904-485-8816
Practice Address - Street 1:1560 KINGSLEY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4593
Practice Address - Country:US
Practice Address - Phone:904-621-0656
Practice Address - Fax:904-485-8816
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW50351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ151LOtherBCBSFL