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NPI Code Detail

MEDICARE: DR. LAWRENCE HARVEY GARD PH.D.

MEDICARE:  DR. LAWRENCE HARVEY GARD  PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist071-004065IL

General Provider Information

NPI Number : 1457380529
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAWRENCE HARVEY GARD PH.D.
Provider Business Mailing Address
First Line : 1 E SCHILLER ST
Second Line : 18-D
City : CHICAGO
State : IL
Zip : 60610-2176
Country : US
Telephone Number : 312-787-9620
Fax Number :
Provider Business Practice Location Address
First Line : 1 S DEARBORN ST
Second Line : 2100
City : CHICAGO
State : IL
Zip : 60603-2302
Country : US
Telephone Number : 312-787-9620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2006
Last Update Date : 02/23/2009

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