Healthcare Provider Details

I. General information

NPI: 1366917619
Provider Name (Legal Business Name): FEQUIERE LAZARE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 E BASIN RD
NEW CASTLE DE
19720-4214
US

IV. Provider business mailing address

148 TYWYN DR
MIDDLETOWN DE
19709-8701
US

V. Phone/Fax

Practice location:
  • Phone: 302-323-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number92293
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: