1821009317 NPI number — DR. DENNISE DAMARIS LAWRY PSY.D.

Table of content: DR. DENNISE DAMARIS LAWRY PSY.D. (NPI 1821009317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821009317 NPI number — DR. DENNISE DAMARIS LAWRY PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRY
Provider First Name:
DENNISE
Provider Middle Name:
DAMARIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VILLA
Provider Other First Name:
DENNISE
Provider Other Middle Name:
DAMARIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821009317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3224 BEE RIDGE RD
Provider Second Line Business Mailing Address:
SAMARITAN COUNSELING SERVICES OF THE GULF COAST, INC.
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34239-7201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-926-2959
Provider Business Mailing Address Fax Number:
941-929-0849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3224 BEE RIDGE RD
Provider Second Line Business Practice Location Address:
SAMARITAN COUNSELING SERVICES OF THE GULF COAST, INC.
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34239-7201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-926-2959
Provider Business Practice Location Address Fax Number:
941-929-0849
Provider Enumeration Date:
08/10/2006

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: 103TC0700X , with the licence number:  PY 7816 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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