Provider Demographics
NPI:1871878140
Name:LAWRENCE, SHLOMO AVINOAM (MS)
Entity type:Individual
Prefix:
First Name:SHLOMO
Middle Name:AVINOAM
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8318 BOCA GLADES BLVD E
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4029
Mailing Address - Country:US
Mailing Address - Phone:954-605-5804
Mailing Address - Fax:
Practice Address - Street 1:8318 BOCA GLADES BLVD E
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4029
Practice Address - Country:US
Practice Address - Phone:954-408-4129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT1067106H00000X
FLMT2918106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist