Provider Demographics
NPI:1104630359
Name:GRENNER, LAWRENCE (LSW)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:GRENNER
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DANTE PL
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1208
Mailing Address - Country:US
Mailing Address - Phone:201-446-2415
Mailing Address - Fax:
Practice Address - Street 1:8 DANTE PL
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1208
Practice Address - Country:US
Practice Address - Phone:201-446-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05172000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker