Provider Demographics
NPI:1871594911
Name:AUSTIN, LAWRENCE R (LICSW)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:R
Last Name:AUSTIN
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 1:28 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2144
Mailing Address - Country:US
Mailing Address - Phone:508-240-7964
Mailing Address - Fax:508-240-5448
Practice Address - Street 1:23 BAY STATE CT
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2120
Practice Address - Country:US
Practice Address - Phone:508-255-8375
Practice Address - Fax:508-240-5448
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10312911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA003154OtherHARVARD PILGRIM
MA268919000OtherHMO BLUE
MA1858700Medicaid
MA1894927Medicaid
MA410321OtherTUFTS
MAP21244OtherBC/BS
MA1858700Medicaid