MEDICARE: MS. BRYNLEY BODINE LAZAR LMSW

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	1041C0700X	Clinical Social Worker	118731-01	NY

General Provider Information

NPI Number	:	1447400809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRYNLEY BODINE LAZAR LMSW

Provider Business Mailing Address
First Line	:	792 PLEASANTVILLE RD
Second Line	:
City	:	BRIARCLIFF MANOR
State	:	NY
Zip	:	10510-2314
Country	:	US
Telephone Number	:	914-582-5674
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 COURT ST STE 409
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11242-1134
Country	:	US
Telephone Number	:	212-405-2685
Fax Number	:

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

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	03/14/2023

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