Provider Demographics
NPI:1942947361
Name:LAWYER, KEVIN (THERAPEUTIC MENTOR)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:LAWYER
Suffix:
Gender:M
Credentials:THERAPEUTIC MENTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492B HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3116
Mailing Address - Country:US
Mailing Address - Phone:208-696-1854
Mailing Address - Fax:
Practice Address - Street 1:492B HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3116
Practice Address - Country:US
Practice Address - Phone:858-573-1384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician