Provider Demographics
NPI:1902356496
Name:LAWRENCE-EVANS, MATTHEW D (LCSW)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:LAWRENCE-EVANS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08099-0123
Mailing Address - Country:US
Mailing Address - Phone:609-247-6591
Mailing Address - Fax:
Practice Address - Street 1:190 N EVERGREEN AVE STE 202
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1862
Practice Address - Country:US
Practice Address - Phone:856-942-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055828001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05582800OtherNEW JERSEY BOARD OF SOCIAL WORK EXAMINERS