Provider Demographics
NPI:1366534489
Name:GORSKI, LAWRENCE E (PSYD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:GORSKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3077 W. JEFFERSON ST.
Mailing Address - Street 2:SUITE 209
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435
Mailing Address - Country:US
Mailing Address - Phone:815-730-3744
Mailing Address - Fax:708-957-3695
Practice Address - Street 1:3077 W. JEFFERSON ST.
Practice Address - Street 2:SUITE 209
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-730-3744
Practice Address - Fax:708-957-3695
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040176A103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200470Medicare ID - Type Unspecified