Provider Demographics
NPI:1326888009
Name:ELISABETH LAWSON, SANDRA FLORENCE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:FLORENCE
Last Name:ELISABETH 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 1:1600 CRESTWOOD CT S APT 1603
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4936
Mailing Address - Country:US
Mailing Address - Phone:561-809-0641
Mailing Address - Fax:
Practice Address - Street 1:1340 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7408
Practice Address - Country:US
Practice Address - Phone:561-962-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1102210106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician