Provider Demographics
NPI:1396763538
Name:SHAPIRO, LAWRENCE ELLIOTT (PHD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ELLIOTT
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9975 LAKE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20886-0603
Mailing Address - Country:US
Mailing Address - Phone:301-977-9492
Mailing Address - Fax:
Practice Address - Street 1:6200 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4119
Practice Address - Country:US
Practice Address - Phone:301-984-3844
Practice Address - Fax:301-230-3169
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2985103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2468OtherCAREFIRST BCBS PROVIDER
MD2468OtherCAREFIRST BCBS PROVIDER