Provider Demographics
NPI:1184212607
Name:NICOLE LAZORWITZ PSYD LLC
Entity Type:Organization
Organization Name:NICOLE LAZORWITZ PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZORWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:520-428-4528
Mailing Address - Street 1:3507 N CENTRAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2121
Mailing Address - Country:US
Mailing Address - Phone:520-428-4528
Mailing Address - Fax:
Practice Address - Street 1:3507 N CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2121
Practice Address - Country:US
Practice Address - Phone:520-428-4528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty