Provider Demographics
NPI:1902545254
Name:LAWRENCE, JEFFREY NATHANIEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NATHANIEL
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E 127TH ST APT 4D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1243
Mailing Address - Country:US
Mailing Address - Phone:914-980-8825
Mailing Address - Fax:
Practice Address - Street 1:574 ATLANTIC AVE APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4911
Practice Address - Country:US
Practice Address - Phone:914-980-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024957103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty