Healthcare Provider Details

I. General information

NPI: 1124328208
Provider Name (Legal Business Name): DEVORAH LAZAR LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2010
Last Update Date: 10/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 EMPIRE BLVD 3A
BROOKLYN NY
11213-5338
US

IV. Provider business mailing address

675 EMPIRE BLVD 3A
BROOKLYN NY
11213-5338
US

V. Phone/Fax

Practice location:
  • Phone: 718-778-9867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004524-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: