Provider Demographics
NPI:1164922993
Name:LAZZARIS, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:LAZZARIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2363
Mailing Address - Country:US
Mailing Address - Phone:860-413-9538
Mailing Address - Fax:860-838-4241
Practice Address - Street 1:835 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2363
Practice Address - Country:US
Practice Address - Phone:860-413-9538
Practice Address - Fax:860-838-4241
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-16-23786103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst