Healthcare Provider Details

I. General information

NPI: 1255092151
Provider Name (Legal Business Name): BETSY LAZARUS ROUSE MA, ATR-BC, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 WATERS EDGE DR STE D
BAYSIDE NY
11360-2214
US

IV. Provider business mailing address

1855 CORPORAL KENNEDY ST APT 1E
BAYSIDE NY
11360-1436
US

V. Phone/Fax

Practice location:
  • Phone: 516-400-2620
  • Fax:
Mailing address:
  • Phone: 516-527-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number000343
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: