Provider Demographics
NPI:1457380529
Name:GARD, LAWRENCE HARVEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:HARVEY
Last Name:GARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E SCHILLER ST
Mailing Address - Street 2:18-D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2176
Mailing Address - Country:US
Mailing Address - Phone:312-787-9620
Mailing Address - Fax:
Practice Address - Street 1:1 S DEARBORN ST
Practice Address - Street 2:2100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-2302
Practice Address - Country:US
Practice Address - Phone:312-787-9620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL915680Medicare ID - Type Unspecified