Healthcare Provider Details

I. General information

NPI: 1770973679
Provider Name (Legal Business Name): MICHAEL LAX PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 E 18TH ST
BROOKLYN NY
11230-7261
US

IV. Provider business mailing address

1580 E 18TH ST
BROOKLYN NY
11230-7261
US

V. Phone/Fax

Practice location:
  • Phone: 732-985-0253
  • Fax:
Mailing address:
  • Phone: 732-985-0253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number020900
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: