Provider Demographics
NPI:1275261042
Name:LAZARUS, KELLY DIONNE (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DIONNE
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 CLARKSON RD # 1030
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4976
Mailing Address - Country:US
Mailing Address - Phone:636-200-8646
Mailing Address - Fax:
Practice Address - Street 1:3724 RIVIERE MARNE CT
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-3101
Practice Address - Country:US
Practice Address - Phone:636-200-8646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care