Provider Demographics
NPI:1063749703
Name:OWENS, LAWRENCE M (LCSW)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:M
Last Name:OWENS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3747
Mailing Address - Country:US
Mailing Address - Phone:207-871-7431
Mailing Address - Fax:207-871-7457
Practice Address - Street 1:100 STATE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3747
Practice Address - Country:US
Practice Address - Phone:207-871-7431
Practice Address - Fax:207-871-7457
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC122241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001853601Medicare PIN