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General NPI Number Information
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NPI Number | 1922193630
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Entity Type | Individual
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Provider Name | LARA ELIZABETH BASKIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 25 ROCKWOOD PL FIRST FLOOR
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4957
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Country | US
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Telephone | 201-735-2036
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Fax |
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Provider Business Mailing Address
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Address Line | 521 PIERMONT AVE S UNIT 506
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City | RIVER VALE
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State | NJ
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Zip | 07675-5720
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Country | US
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Telephone | 917-273-7896
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Fax | 201-735-2036
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | SI 03629
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 012492
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 012492
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | SI03629
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | SI 03629
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License Number State | NJ
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