Provider Demographics
NPI:1598724981
Name:MALTZ, LAWRENCE JEFFREY (LCSW)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JEFFREY
Last Name:MALTZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:MALTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2895 OAK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3694
Mailing Address - Country:US
Mailing Address - Phone:541-484-4480
Mailing Address - Fax:541-345-2767
Practice Address - Street 1:2895 OAK ST
Practice Address - Street 2:SUITE B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3694
Practice Address - Country:US
Practice Address - Phone:541-484-4480
Practice Address - Fax:541-345-2767
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TLBCKMedicare ID - Type Unspecified