Provider Demographics
NPI:1134517691
Name:ZAWACKI, LARA (PSY D)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:ZAWACKI
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 COBALT DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-5201
Mailing Address - Country:US
Mailing Address - Phone:408-205-1712
Mailing Address - Fax:
Practice Address - Street 1:130 W. E ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3519
Practice Address - Country:US
Practice Address - Phone:408-205-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2831103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool