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General NPI Number Information
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NPI Number | 1306230982
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Entity Type | Individual
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Provider Name | LAURENCE ROOSEVELT JONES
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Gender | Male
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 04/09/2022
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Provider Practice Location Address
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Address Line | 112 LONSDALE RD
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City | BUFFALO
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State | NY
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Zip | 14208-1532
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Country | US
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Telephone | 716-520-7547
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Fax | 716-235-8250
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Provider Business Mailing Address
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Address Line | 112 LONSDALE RD
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City | BUFFALO
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State | NY
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Zip | 14208-1532
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Country | US
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Telephone | 716-520-7547
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Fax | 716-235-8250
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 093926
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 275234-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0887337
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License Number State | NY
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