Healthcare Provider Details

I. General information

NPI: 1497184295
Provider Name (Legal Business Name): SARAH BETH LAZER-GOMEZ PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 LEXINGTON AVE 17TH FLOOR, OFFICE 1770
NEW YORK NY
10168-0002
US

IV. Provider business mailing address

380 LEXINGTON AVE 17TH FLOOR, OFFICE 1770
NEW YORK NY
10168-0002
US

V. Phone/Fax

Practice location:
  • Phone: 646-461-3857
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020335
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: