Provider Demographics
NPI:1225876535
Name:DE JESUS-LAWSON, DESTINY MARIA
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:MARIA
Last Name:DE JESUS-LAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6374
Mailing Address - Country:US
Mailing Address - Phone:959-465-9624
Mailing Address - Fax:
Practice Address - Street 1:28 GORMAN CIR
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-2623
Practice Address - Country:US
Practice Address - Phone:646-531-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker