Provider Demographics
NPI:1679030282
Name:CREAMER, LAWRENCE BERNARD JR (CAADC)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:BERNARD
Last Name:CREAMER
Suffix:JR
Gender:M
Credentials:CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:COLWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19123-0000
Mailing Address - Country:US
Mailing Address - Phone:609-458-8787
Mailing Address - Fax:
Practice Address - Street 1:1223 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1235
Practice Address - Country:US
Practice Address - Phone:484-445-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1411101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)