Provider Demographics
NPI:1841590106
Name:LAWLOR, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LAWLOR
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 1:196 COURT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3302
Mailing Address - Country:US
Mailing Address - Phone:860-344-5510
Mailing Address - Fax:860-344-5507
Practice Address - Street 1:196 COURT ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3302
Practice Address - Country:US
Practice Address - Phone:860-344-5510
Practice Address - Fax:860-344-5507
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)