Provider Demographics
NPI:1942230180
Name:VADEBONCOEUR, LAWRENCE EDWARD (MSW LICSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:VADEBONCOEUR
Suffix:
Gender:M
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BRISTOL AVE
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2606
Mailing Address - Country:US
Mailing Address - Phone:774-487-2102
Mailing Address - Fax:
Practice Address - Street 1:126 RTGA
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563
Practice Address - Country:US
Practice Address - Phone:774-487-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10195951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical