Provider Demographics
NPI:1053566182
Name:LAWRENCE, KATHRYN A (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:101 OAK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-3040
Mailing Address - Country:US
Mailing Address - Phone:317-727-9223
Mailing Address - Fax:
Practice Address - Street 1:6105 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1525
Practice Address - Country:US
Practice Address - Phone:260-450-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YS0200X, 1041C0700X
IN34007473A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool