Healthcare Provider Details

I. General information

NPI: 1740401926
Provider Name (Legal Business Name): CLIFFORD NEIL LAZARUS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 TAMARACK CIR
SKILLMAN NJ
08558-2020
US

IV. Provider business mailing address

38 BROOK DR E
PRINCETON NJ
08540-9520
US

V. Phone/Fax

Practice location:
  • Phone: 609-683-9122
  • Fax: 609-683-5229
Mailing address:
  • Phone: 609-497-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00293800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: