Healthcare Provider Details

I. General information

NPI: 1336282615
Provider Name (Legal Business Name): LAWRENCE ALLEN PROPPER MSW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 NORTH COUNTRY RD SUITE 101
MT SINAI NY
11766
US

IV. Provider business mailing address

28 NORTH COUNTRY RD SUITE 101
MT SINAI NY
11766
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-2596
  • Fax:
Mailing address:
  • Phone: 631-928-2596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR021518
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: