Basic Information
| Provider Information | |||||||||
| NPI: | 1619376704 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAWRENCE W SCHWARZ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 N TYLER ST | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704331456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042615715 | ||||||||
| FaxNumber: | 9857814319 | ||||||||
| Practice Location | |||||||||
| Address1: | 208 N TYLER ST | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704331456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042615715 | ||||||||
| FaxNumber: | 9857814319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2014 | ||||||||
| LastUpdateDate: | 08/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARZ | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5042615715 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7427 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7427 | 01 | LA | LCSW 7427 | OTHER |