Provider Demographics
NPI:1346401106
Name:LAZARUS, DEBORAH
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 PARK AVE
Mailing Address - Street 2:SUITE 1SC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1758
Mailing Address - Country:US
Mailing Address - Phone:212-787-4183
Mailing Address - Fax:
Practice Address - Street 1:1225 PARK AVE
Practice Address - Street 2:SUITE 1SC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1758
Practice Address - Country:US
Practice Address - Phone:212-787-4183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
014065103T00000X
NY014065103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent