1891822409 NPI number — MRS. JOYCE MARIE LAWLER LICENSED PSYCHOLOGIS

Table of content: MRS. JOYCE MARIE LAWLER LICENSED PSYCHOLOGIS (NPI 1891822409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891822409 NPI number — MRS. JOYCE MARIE LAWLER LICENSED PSYCHOLOGIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWLER
Provider First Name:
JOYCE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED PSYCHOLOGIS
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:
1891822409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 3RD AVENUE SE
Provider Second Line Business Mailing Address:
IRONWOOD SQUARE SUITE 201
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-289-5992
Provider Business Mailing Address Fax Number:
507-529-3669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 3RD AVENUE SE
Provider Second Line Business Practice Location Address:
IRONWOOD SQUARE SUITE 201
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-289-5992
Provider Business Practice Location Address Fax Number:
507-529-3669
Provider Enumeration Date:
02/28/2007

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: 103T00000X , with the licence number:  LP3812 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 16472 . This is a "MAYO PROVIDER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 30Q10LA . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 654326000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125478 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 30Q09LA . This is a "BCBS GROUP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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