Provider Demographics
NPI:1518403260
Name:NAHAS, LARA
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:NAHAS
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 1:2037 UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3215
Mailing Address - Country:US
Mailing Address - Phone:718-377-5755
Mailing Address - Fax:
Practice Address - Street 1:2037 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3215
Practice Address - Country:US
Practice Address - Phone:718-377-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP05038OtherMENTAL HEALTH COUNSELOR - LIMITED PERMIT