Provider Demographics
NPI:1700082385
Name:LAWRENCE, CHARLENE M
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 LAS LOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2430
Mailing Address - Country:US
Mailing Address - Phone:310-454-9509
Mailing Address - Fax:
Practice Address - Street 1:1527 4TH ST
Practice Address - Street 2:STE 200
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2358
Practice Address - Country:US
Practice Address - Phone:310-576-2550
Practice Address - Fax:310-576-2499
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker