Healthcare Provider Details

I. General information

NPI: 1598116923
Provider Name (Legal Business Name): RACHAEL ELIZABETH LAX PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 PARK AVE
ROCHESTER NY
14607-2415
US

IV. Provider business mailing address

374 WIMBLEDON RD
ROCHESTER NY
14617-4728
US

V. Phone/Fax

Practice location:
  • Phone: 585-530-9484
  • Fax:
Mailing address:
  • Phone: 585-530-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: