Provider Demographics
NPI:1154977270
Name:LAWRENCE, NADINE ALISON (PSYD)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:ALISON
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PROSPECT AVE APT 703
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2587
Mailing Address - Country:US
Mailing Address - Phone:917-514-4406
Mailing Address - Fax:
Practice Address - Street 1:350 PROSPECT AVE APT 703
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2587
Practice Address - Country:US
Practice Address - Phone:917-514-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015218103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist