Provider Demographics
NPI:1568272540
Name:LAWRENCE, MARIAH
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:LAWRENCE
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 1:4140 CONLEY DR
Mailing Address - Street 2:
Mailing Address - City:WEST ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:45381-8367
Mailing Address - Country:US
Mailing Address - Phone:559-917-7726
Mailing Address - Fax:
Practice Address - Street 1:1000 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3236
Practice Address - Country:US
Practice Address - Phone:513-478-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.1900103-SUPV106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist