Provider Demographics
NPI:1326068610
Name:LAZERE, MONICA BRIDGET (LCSW LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:BRIDGET
Last Name:LAZERE
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:BRIDGET
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2350 SOUTH AVENUE
Mailing Address - Street 2:STE 102
Mailing Address - City:LACROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601
Mailing Address - Country:US
Mailing Address - Phone:608-787-6645
Mailing Address - Fax:608-787-6658
Practice Address - Street 1:2350 SOUTH AVENUE
Practice Address - Street 2:STE 102
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-787-6645
Practice Address - Fax:608-787-6658
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1316103T00000X
WI242103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39562900Medicaid