Healthcare Provider Details

I. General information

NPI: 1114913720
Provider Name (Legal Business Name): JEFFREY R LAWRENCE MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 CENTRAL AVE STE 200
WOODMERE NY
11598-1204
US

IV. Provider business mailing address

949 CENTRAL AVE STE 200
WOODMERE NY
11598-1204
US

V. Phone/Fax

Practice location:
  • Phone: 516-374-1360
  • Fax: 516-536-0313
Mailing address:
  • Phone: 516-374-1360
  • Fax: 516-536-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR007430-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: