Provider Demographics
NPI:1457112781
Name:LAWRENCE, SIMONE MICHELE (PMHNP)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:MICHELE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4048
Mailing Address - Country:US
Mailing Address - Phone:845-600-5214
Mailing Address - Fax:
Practice Address - Street 1:1663 ROUTE 22
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4048
Practice Address - Country:US
Practice Address - Phone:845-600-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF405557-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health