Provider Demographics
NPI:1063689289
Name:LAWSON, MARY ROBERTS (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ROBERTS
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 GREENES WAY CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3184
Mailing Address - Country:US
Mailing Address - Phone:610-564-1090
Mailing Address - Fax:
Practice Address - Street 1:3011 GREENES WAY CIR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3184
Practice Address - Country:US
Practice Address - Phone:610-564-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical