Provider Demographics
NPI:1295890325
Name:LANDAU, BETSY (PHD)
Entity type:Individual
Prefix:DR
First Name:BETSY
Middle Name:
Last Name:LANDAU
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 1:9415 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5857
Mailing Address - Country:US
Mailing Address - Phone:718-268-5829
Mailing Address - Fax:718-575-9667
Practice Address - Street 1:9415 69TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5857
Practice Address - Country:US
Practice Address - Phone:718-268-5829
Practice Address - Fax:718-575-9667
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008781-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011025OtherVALUE OPTIONS
NY01145275Medicaid
NYV4A311OtherBLUE CROSS/BLUE SHIELD
NY011025OtherVALUE OPTIONS