Provider Demographics
NPI:1134440951
Name:WARD, LAWRENCE
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:WARD
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 1:2 REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8713
Mailing Address - Country:US
Mailing Address - Phone:607-277-4184
Mailing Address - Fax:
Practice Address - Street 1:950 DANBY RD
Practice Address - Street 2:SUITE 179, CHALLENGE INDUSTRIES
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5778
Practice Address - Country:US
Practice Address - Phone:607-272-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0219261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical