Provider Demographics
NPI:1699571331
Name:LAWRENCE, BRIANNA DANIELLE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:DANIELLE
Last Name:LAWRENCE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:DANIELLE
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2208 GATEWAY CIR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6733
Mailing Address - Country:US
Mailing Address - Phone:209-200-7548
Mailing Address - Fax:
Practice Address - Street 1:2208 GATEWAY CIR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6733
Practice Address - Country:US
Practice Address - Phone:209-200-7548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician