Provider Demographics
NPI:1265553028
Name:TRUST, LAWRENCE (LICSW)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:TRUST
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 DAVIDSON RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1320
Mailing Address - Country:US
Mailing Address - Phone:508-853-9935
Mailing Address - Fax:
Practice Address - Street 1:30 SEVER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2194
Practice Address - Country:US
Practice Address - Phone:508-688-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1060561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical