Provider Demographics
NPI:1750435046
Name:FIEMAN, LAWRENCE S (EDD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S
Last Name:FIEMAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DOVE AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2944
Mailing Address - Country:US
Mailing Address - Phone:978-745-9003
Mailing Address - Fax:978-825-8622
Practice Address - Street 1:4 DOVE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2944
Practice Address - Country:US
Practice Address - Phone:978-745-9003
Practice Address - Fax:978-825-8622
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3652103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03727OtherBLUE CROSS OF MA
MA0517747Medicaid
MAW10418OtherBLUE CROSS OF MA GROUP
MAW40017Medicare ID - Type Unspecified