Provider Demographics
NPI:1164892923
Name:LAZAROVA, ANNIEROSE (LMFT)
Entity Type:Individual
Prefix:
First Name:ANNIEROSE
Middle Name:
Last Name:LAZAROVA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91603-0527
Mailing Address - Country:US
Mailing Address - Phone:818-220-3493
Mailing Address - Fax:
Practice Address - Street 1:23123 VENTURA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-220-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist