MEDICARE: JACK HAZAN LMHC , CSAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		NY
2	101YM0800X	Mental Health Counselor	010783	NY

General Provider Information

NPI Number	:	1376022079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK HAZAN LMHC , CSAT

Provider Business Mailing Address
First Line	:	401 W 25TH ST APT 13C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-6575
Country	:	US
Telephone Number	:	917-453-9306
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 BAY RD APT 2003
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3277
Country	:	US
Telephone Number	:	917-453-9306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	02/07/2025

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