Provider Demographics
NPI:1013136001
Name:LAWLOR, MARY ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY ELLEN
Middle Name:
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY ELLEN
Other - Middle Name:
Other - Last Name:MERRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:464 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2925
Mailing Address - Country:US
Mailing Address - Phone:518-792-7927
Mailing Address - Fax:
Practice Address - Street 1:464 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2925
Practice Address - Country:US
Practice Address - Phone:518-792-7927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10781103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01243365Medicaid
NY01243365Medicaid