1013062827 NPI number — DR. JUDITH WILNER LAWRENCE

Table of content: DR. JUDITH WILNER LAWRENCE (NPI 1013062827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013062827 NPI number — DR. JUDITH WILNER LAWRENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
Provider First Name:
JUDITH
Provider Middle Name:
WILNER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013062827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1577 BEACON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02446-4602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-739-1212
Provider Business Mailing Address Fax Number:
617-731-8585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1577 BEACON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02446-4602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-739-1212
Provider Business Practice Location Address Fax Number:
617-731-8585
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  7154 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7154 . This is a "STATE PSYCHOLOGY LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W05753 . This is a "BCBS PIN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com