Provider Demographics
NPI:1760865455
Name:STEVENSON, LAWRENCE JAQUAN
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:JAQUAN
Last Name:STEVENSON
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 1:127 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MA
Mailing Address - Zip Code:02322-1238
Mailing Address - Country:US
Mailing Address - Phone:508-631-5561
Mailing Address - Fax:
Practice Address - Street 1:127 W HIGH ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:MA
Practice Address - Zip Code:02322-1238
Practice Address - Country:US
Practice Address - Phone:508-631-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health