Provider Demographics
NPI:1720153687
Name:JOSEPHS, LAWRENCE (PHD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:JOSEPHS
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 1:210 E 68TH ST STE 1H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6024
Mailing Address - Country:US
Mailing Address - Phone:212-861-7027
Mailing Address - Fax:212-746-4554
Practice Address - Street 1:210 E 68TH ST STE 1H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6024
Practice Address - Country:US
Practice Address - Phone:212-861-7027
Practice Address - Fax:212-746-4554
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7308103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV30931Medicare ID - Type Unspecified
R52666Medicare UPIN