Provider Demographics
NPI:1912310327
Name:LAWRENCE, ANGELA (PSYD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 W 254TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1247
Mailing Address - Country:US
Mailing Address - Phone:718-548-2727
Mailing Address - Fax:718-548-4400
Practice Address - Street 1:655 W 254TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1247
Practice Address - Country:US
Practice Address - Phone:718-548-2727
Practice Address - Fax:718-548-4400
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021178171W00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No171W00000XOther Service ProvidersContractor