Healthcare Provider Details

I. General information

NPI: 1871343616
Provider Name (Legal Business Name): ANJANAE J. LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 SHELDON DR
MONTICELLO NY
12701-4122
US

IV. Provider business mailing address

30 HILLCREST VLG W APT C4
NISKAYUNA NY
12309-3829
US

V. Phone/Fax

Practice location:
  • Phone: 845-513-5754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: