MEDICARE: JACLYN LAWRENCE

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
1	1041C0700X	Clinical Social Worker	099134	NY

General Provider Information

NPI Number	:	1730631920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN LAWRENCE

Provider Business Mailing Address
First Line	:	260 MADISON AVE STE 8006
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-2400
Country	:	US
Telephone Number	:	212-335-0511
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 MADISON AVE STE 8006
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-2400
Country	:	US
Telephone Number	:	212-335-0511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2016
Last Update Date	:	01/03/2025

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Directions to “ JACLYN LAWRENCE ” Practice Location

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