Provider Demographics
NPI:1841505351
Name:LASKER, EBEN HOUSEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:EBEN
Middle Name:HOUSEN
Last Name:LASKER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BEACON ST STE 225
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3200
Mailing Address - Country:US
Mailing Address - Phone:617-512-4619
Mailing Address - Fax:
Practice Address - Street 1:1330 BEACON ST STE 225
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3200
Practice Address - Country:US
Practice Address - Phone:617-512-4619
Practice Address - Fax:888-972-8213
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9841103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical