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General NPI Number Information
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NPI Number | 1902545254
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Entity Type | Individual
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Provider Name | JEFFREY NATHANIEL LAWRENCE PSY.D
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Gender | Male
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 574 ATLANTIC AVE APT 2
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City | BROOKLYN
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State | NY
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Zip | 11217-4911
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Country | US
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Telephone | 914-980-8825
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Fax |
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Provider Business Mailing Address
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Address Line | 31 E 127TH ST APT 4D
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City | NEW YORK
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State | NY
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Zip | 10035-1243
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Country | US
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Telephone | 914-980-8825
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Fax |
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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 | 024957
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License Number State | NY
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