Healthcare Provider Details

I. General information

NPI: 1447400809
Provider Name (Legal Business Name): BRYNLEY BODINE LAZAR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST STE 409
BROOKLYN NY
11242-1134
US

IV. Provider business mailing address

792 PLEASANTVILLE RD
BRIARCLIFF MANOR NY
10510-2314
US

V. Phone/Fax

Practice location:
  • Phone: 212-405-2685
  • Fax:
Mailing address:
  • Phone: 914-582-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118731-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: