Healthcare Provider Details

I. General information

NPI: 1083361414
Provider Name (Legal Business Name): EMILY LAZAR PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 03/06/2022
Certification Date: 03/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 STATE FARM RD STE 507-5
BOONE NC
28607-4917
US

IV. Provider business mailing address

120 BAMBAMS LN UNIT A
BOONE NC
28607-9406
US

V. Phone/Fax

Practice location:
  • Phone: 828-338-3136
  • Fax:
Mailing address:
  • Phone: 317-902-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPP5429
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: