Healthcare Provider Details

I. General information

NPI: 1235591363
Provider Name (Legal Business Name): JESSICA B LAWRENCE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 GREAT RD STE G1
ACTON MA
01720-4766
US

IV. Provider business mailing address

100 TER HEUN DR
FALMOUTH MA
02540-2503
US

V. Phone/Fax

Practice location:
  • Phone: 978-679-1200
  • Fax: 978-486-4037
Mailing address:
  • Phone: 508-495-8517
  • Fax: 508-477-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number284923
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: