Provider Demographics
NPI:1316002595
Name:LAWRENCE, LOUISA Q (LOUISA LAWRENCE CSW)
Entity type:Individual
Prefix:MS
First Name:LOUISA
Middle Name:Q
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LOUISA LAWRENCE CSW
Other - Prefix:MS
Other - First Name:LOUISA
Other - Middle Name:Q
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LOUISA LAWRENCE CSW
Mailing Address - Street 1:169 E 78TH ST
Mailing Address - Street 2:APT. 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0485
Mailing Address - Country:US
Mailing Address - Phone:212-288-4736
Mailing Address - Fax:
Practice Address - Street 1:163 E 82ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1856
Practice Address - Country:US
Practice Address - Phone:212-794-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0265691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN5A751Medicare PIN