Individual
DR. LAWRENCE PAUL MAUCIERI JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
203 N WABASH AVE, SUITE 2106, CHICAGO, IL 60601-2406
(773) 401-9831
Mailing address
640 W SHERIDAN RD, APARTMENT 409, CHICAGO, IL 60613-3320
(773) 401-9831
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1635586
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/26/2006
Last updated
07/08/2007
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