Healthcare Provider Details

I. General information

NPI: 1861096612
Provider Name (Legal Business Name): LAWRENCE J NORMILE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 N DUPONT HWY
DOVER DE
19901-3906
US

IV. Provider business mailing address

462 N DUPONT HWY
DOVER DE
19901-3906
US

V. Phone/Fax

Practice location:
  • Phone: 302-264-9135
  • Fax:
Mailing address:
  • Phone: 302-264-9135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: