Healthcare Provider Details

I. General information

NPI: 1205821105
Provider Name (Legal Business Name): LAURENCE W. STUDER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAF UPWOOD UNIT 5610 BOX 223
APO AE
09470-5610
GB

IV. Provider business mailing address

PSC 47 BOX 584
APO AE
09470
GB

V. Phone/Fax

Practice location:
  • Phone: 01487811039
  • Fax:
Mailing address:
  • Phone: 01480417131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC6175
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: