Provider Demographics
NPI:1649355629
Name:LAWSON, LAWRENCE (LARRY) EDWARD (MASTER OF SOCIAL WOR)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE (LARRY)
Middle Name:EDWARD
Last Name:LAWSON
Suffix:
Gender:M
Credentials:MASTER OF SOCIAL WOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 12TH STREET CUTOFF SE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-391-2363
Mailing Address - Fax:503-315-7571
Practice Address - Street 1:4035 12TH STREET CUTOFF SE
Practice Address - Street 2:SUITE 140
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-391-2363
Practice Address - Fax:503-315-7571
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL0005671041C0700X
ORT0197106H00000X
ORL5671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR100160Medicare ID - Type UnspecifiedMEDICARE