Provider Demographics
NPI:1023353034
Name:IACARINO, LAWRENCE G
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:G
Last Name:IACARINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 BENFIELD BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2639
Mailing Address - Country:US
Mailing Address - Phone:410-987-3448
Mailing Address - Fax:410-987-4710
Practice Address - Street 1:1110 BENFIELD BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2639
Practice Address - Country:US
Practice Address - Phone:410-987-3448
Practice Address - Fax:410-987-4710
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-02
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MDA0216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health