Provider Demographics
NPI:1922193630
Name:BASKIN, LARA ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:ELIZABETH
Last Name:BASKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 PIERMONT AVE S
Mailing Address - Street 2:UNIT 506
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-5720
Mailing Address - Country:US
Mailing Address - Phone:917-273-7896
Mailing Address - Fax:201-735-2036
Practice Address - Street 1:25 ROCKWOOD PL
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4957
Practice Address - Country:US
Practice Address - Phone:201-735-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI 03629103G00000X, 103TC0700X
NY012492103G00000X, 103TC0700X
NJSI03629103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP2347822OtherOXFORD OUT-OF-NETWORK ID
NYV8274OtherEMPIRE BCBS OUT-NETWORK
NJ021852Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NJP00137157Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NJP2347822OtherOXFORD OUT-OF-NETWORK ID