Provider Demographics
NPI:1033327622
Name:LASK, MICHELLE BARBARA (EDM, CRC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:BARBARA
Last Name:LASK
Suffix:
Gender:F
Credentials:EDM, CRC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 E 20TH ST
Mailing Address - Street 2:7E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-1410
Mailing Address - Country:US
Mailing Address - Phone:212-777-7253
Mailing Address - Fax:
Practice Address - Street 1:622 E 20TH ST
Practice Address - Street 2:7E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-1410
Practice Address - Country:US
Practice Address - Phone:212-987-7185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000840-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health