Provider Demographics
NPI:1255092151
Name:LAZARUS ROUSE, BETSY (MA, ATR-BC, LCAT)
Entity type:Individual
Prefix:MS
First Name:BETSY
Middle Name:
Last Name:LAZARUS ROUSE
Suffix:
Gender:F
Credentials:MA, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 CORPORAL KENNEDY ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1436
Mailing Address - Country:US
Mailing Address - Phone:516-527-7990
Mailing Address - Fax:
Practice Address - Street 1:2350 WATERS EDGE DR STE D
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2214
Practice Address - Country:US
Practice Address - Phone:516-400-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000343221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist