Healthcare Provider Details

I. General information

NPI: 1093910721
Provider Name (Legal Business Name): ALBERT EDWARD LAWRENCE III M.ED., LMHC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PORTER ST 1ST FLOOR
STOUGHTON MA
02072-2978
US

IV. Provider business mailing address

PO BOX 2262
TAUNTON MA
02780-0965
US

V. Phone/Fax

Practice location:
  • Phone: 781-708-4504
  • Fax: 781-341-7272
Mailing address:
  • Phone: 774-644-1622
  • Fax: 781-341-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7518
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: