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General NPI Number Information
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NPI Number | 1235379132
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Entity Type | Individual
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Provider Name | LAWRENCE B. LENNON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 03/05/2009
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Provider Practice Location Address
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Address Line | 2633 E 136TH ST
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City | CARMEL
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State | IN
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Zip | 46032-1855
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Country | US
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Telephone | 317-575-9645
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Fax | 317-575-9653
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Provider Business Mailing Address
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Address Line | PO BOX 501
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City | CARMEL
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State | IN
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Zip | 46082-0501
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Country | US
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Telephone | 317-575-9645
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Fax | 317-575-9653
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20010358A
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License Number State | IN
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