Provider Demographics
NPI:1710257498
Name:LAZARUS, CHERYL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:LAZARUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:202 PATRICIA PL
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1852
Mailing Address - Country:US
Mailing Address - Phone:973-773-1234
Mailing Address - Fax:
Practice Address - Street 1:105 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5474
Practice Address - Country:US
Practice Address - Phone:845-577-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist