1235292079 NPI number — MR. LAWRENCE DAVID HANELLY LPC

Table of content: ARIKA DANIELLE GUINN (NPI 1881462679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235292079 NPI number — MR. LAWRENCE DAVID HANELLY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANELLY
Provider First Name:
LAWRENCE
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

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:
1235292079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 EAST FIFTH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLWOOD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16617-2015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-742-1216
Provider Business Mailing Address Fax Number:
814-949-9345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
809 ROUTE 764
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCANSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-215-3766
Provider Business Practice Location Address Fax Number:
814-949-9345
Provider Enumeration Date:
12/19/2006

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: 101YA0400X , with the licence number:  LPC000280 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LPC000280 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: PC000280 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: PC000280 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0105602 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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