=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366492316
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAWRENCE J. COLLURA M.S.W
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 02/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 ROCKFIELD RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15243-1408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-221-8106
-----------------------------------------------------
Fax | 412-319-0708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 ROCKFIELD RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15243-1408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-221-8106
-----------------------------------------------------
Fax | 412-319-0708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW-000224-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------