Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103K00000X | Behavior Analyst |
NPI | 1003234279 |
---|---|
Provider Name | Elizabeth Lawrence |
First Address | Bedford, MA 01730-1406 |
Second Address | Bedford, MA 01730-1406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 11/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000023532 | BMC (01) | MA |
042611055 | TAX ID (01) | MA |
1004745 | FALLON (01) | MA |
1004745 | NHP (01) | MA |
1303287 | MBHP (01) | MA |
99618201 | NETWORK HEATH (01) | MA |
M18633 | BCBS (01) | MA |