Healthcare Provider Details

I. General information

NPI: 1265402234
Provider Name (Legal Business Name): BEATRICE S. LAZAROFF PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CLAIREMONT RD
VILLANOVA PA
19085-1705
US

IV. Provider business mailing address

401 CLAIREMONT RD
VILLANOVA PA
19085-1705
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-8537
  • Fax: 610-566-6637
Mailing address:
  • Phone: 610-527-8537
  • Fax: 610-566-6637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS-003140-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: