Provider Demographics
NPI:1255504056
Name:LAZARO, LYDIA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:M
Last Name:LAZARO
Suffix:
Gender:F
Credentials:PHD
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 8129
Mailing Address - Street 2:LOS PRADOS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8129
Mailing Address - Country:US
Mailing Address - Phone:787-994-6746
Mailing Address - Fax:
Practice Address - Street 1:9201 URB SERENNA
Practice Address - Street 2:LOS PRADOS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-3318
Practice Address - Country:US
Practice Address - Phone:787-994-6746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2995103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical