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General NPI Number Information
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NPI Number | 1255092151
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Entity Type | Individual
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Provider Name | BETSY LAZARUS ROUSE MA, ATR-BC, LCAT
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Gender | Female
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 2350 WATERS EDGE DR STE D
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City | BAYSIDE
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State | NY
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Zip | 11360-2214
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Country | US
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Telephone | 516-400-2620
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Fax |
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Provider Business Mailing Address
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Address Line | 1855 CORPORAL KENNEDY ST APT 1E
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City | BAYSIDE
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State | NY
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Zip | 11360-1436
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Country | US
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Telephone | 516-527-7990
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 000343
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License Number State | NY
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