Provider Demographics
NPI:1932294337
Name:ALSSID, LAWRENCE LAZARE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:LAZARE
Last Name:ALSSID
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 PARK AVE.
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3799
Mailing Address - Country:US
Mailing Address - Phone:516-221-4708
Mailing Address - Fax:516-221-4709
Practice Address - Street 1:3375 PARK AVE.
Practice Address - Street 2:SUITE 4000
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3799
Practice Address - Country:US
Practice Address - Phone:516-221-4708
Practice Address - Fax:516-221-4709
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV27001Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST