Provider Demographics
NPI:1780117739
Name:HAZEL, KAREN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:HAZEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 FORT WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2003
Mailing Address - Country:US
Mailing Address - Phone:212-740-5157
Mailing Address - Fax:212-740-8566
Practice Address - Street 1:554 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2003
Practice Address - Country:US
Practice Address - Phone:212-740-5157
Practice Address - Fax:212-740-8566
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08585103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent