Healthcare Provider Details

I. General information

NPI: 1750435046
Provider Name (Legal Business Name): LAWRENCE S FIEMAN ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DOVE AVE
SALEM MA
01970-2944
US

IV. Provider business mailing address

4 DOVE AVE
SALEM MA
01970-2944
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-9003
  • Fax: 978-825-8622
Mailing address:
  • Phone: 978-745-9003
  • Fax: 978-825-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3652
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: