MEDICARE: MR. LAWRENCE J. COLLURA M.S.W

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW-000224-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	633825	OTHER	PA	HIGHMARK
2	550534000	OTHER	PA	SELECT BLUE
3	010986	OTHER	PA	CHAMPUS; OPTIONS; TRICARE
4	462181000	OTHER	PA	MAGELLAN EAP
5	4610061	OTHER	PA	AETNA
6	366207	OTHER	PA	CIGNA EAP
7	C9998-0	OTHER	PA	VRI

General Provider Information

NPI Number	:	1366492316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE J. COLLURA M.S.W

Provider Business Mailing Address
First Line	:	310 ROCKFIELD RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15243-1408
Country	:	US
Telephone Number	:	412-221-8106
Fax Number	:	412-319-0708

Provider Business Practice Location Address
First Line	:	310 ROCKFIELD RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15243-1408
Country	:	US
Telephone Number	:	412-221-8106
Fax Number	:	412-319-0708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	02/23/2010

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Directions to “ MR. LAWRENCE J. COLLURA M.S.W” Practice Location

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