Healthcare Provider Details

I. General information

NPI: 1871594911
Provider Name (Legal Business Name): LAWRENCE R AUSTIN LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BAY STATE CT
BREWSTER MA
02631-2120
US

IV. Provider business mailing address

28 CEDAR LN
BREWSTER MA
02631-2144
US

V. Phone/Fax

Practice location:
  • Phone: 508-255-8375
  • Fax: 508-240-5448
Mailing address:
  • Phone: 508-240-7964
  • Fax: 508-240-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1031291
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: