Provider Demographics
NPI:1962805341
Name:LAWRENCE, MICHAEL (CASAC 18008)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:CASAC 18008
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 HOME ST
Mailing Address - Street 2:APT 2M
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2618
Mailing Address - Country:US
Mailing Address - Phone:347-341-2793
Mailing Address - Fax:
Practice Address - Street 1:1600 MACOMBS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-2016
Practice Address - Country:US
Practice Address - Phone:718-299-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18008101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)