Provider Demographics
NPI:1275563728
Name:LAZERWITZ, JERROLD LEE (MSW)
Entity Type:Individual
Prefix:MR
First Name:JERROLD
Middle Name:LEE
Last Name:LAZERWITZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3369 EAST BROAD ST
Mailing Address - Street 2:STE D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213
Mailing Address - Country:US
Mailing Address - Phone:614-231-6528
Mailing Address - Fax:614-231-3710
Practice Address - Street 1:3369 EAST BROAD ST
Practice Address - Street 2:STE D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-231-6528
Practice Address - Fax:614-231-3710
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLISWI13341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LASW28331Medicare ID - Type Unspecified