Provider Demographics
NPI:1730212226
Name:ERES, LAWRENCE DANIEL (LCSW, LADAC)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:DANIEL
Last Name:ERES
Suffix:
Gender:M
Credentials:LCSW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 1363, ABERDEEN AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE SANDS MISSILE RANGE
Mailing Address - State:NM
Mailing Address - Zip Code:88002
Mailing Address - Country:US
Mailing Address - Phone:575-674-3552
Mailing Address - Fax:
Practice Address - Street 1:BLDG 1363, ABERDEEN AVE
Practice Address - Street 2:
Practice Address - City:WHITE SANDS MISSILE RANGE
Practice Address - State:NM
Practice Address - Zip Code:88002
Practice Address - Country:US
Practice Address - Phone:575-674-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0117991101YA0400X
NMI-077071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)