Healthcare Provider Details

I. General information

NPI: 1740572718
Provider Name (Legal Business Name): CURTIS L LAWRENCE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3574 US 1 S SUITE 113
ST AUGUSTINE FL
32086-6466
US

IV. Provider business mailing address

3574 US 1 S SUITE 113
ST AUGUSTINE FL
32086-6466
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-3115
  • Fax: 904-797-2915
Mailing address:
  • Phone: 904-797-3115
  • Fax: 904-797-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: