Healthcare Provider Details

I. General information

NPI: 1679935985
Provider Name (Legal Business Name): AMBER DAWN LAZARUS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER D. LAZARUS LLC

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1979 W HILLSBORO BLVD
DEERFIELD BEACH FL
33442-1444
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 954-428-4800
  • Fax:
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberPY 8979
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 8979
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY 8979
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY 8979
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPY 8979
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY8979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: