Provider Demographics
NPI:1649343377
Name:LAWRENCE, JANET (LICSW)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:SECAP
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-562-5379
Mailing Address - Fax:617-562-5384
Practice Address - Street 1:75 MOUNT AUBURN STREET
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-496-0144
Practice Address - Fax:617-496-0144
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10206781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06154OtherBLUE CROSS
MAP06154OtherBLUE CROSS