Healthcare Provider Details

I. General information

NPI: 1326879123
Provider Name (Legal Business Name): ZORYN LAZARUS-THEODORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALABRESE DR
PINE BUSH NY
12566-5710
US

IV. Provider business mailing address

3 CALABRESE DR
PINE BUSH NY
12566-5710
US

V. Phone/Fax

Practice location:
  • Phone: 845-313-8164
  • Fax:
Mailing address:
  • Phone: 845-313-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098108-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: