Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 10781 | NY |
Y | 103TC0700X | Clinical Psychologist | 10781 | NY |
NPI | 1013136001 |
---|---|
Provider Name | Dr. Mary Ellen Lawlor |
First Address | Glens Falls, NY 12801-2925 |
Second Address | Glens Falls, NY 12801-2925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 24/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01243365 | (05) | NY |