Provider Demographics
NPI:1326437716
Name:CHEPE, LAZARO (CBHCMS)
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:CHEPE
Suffix:
Gender:M
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 NW 107TH AVE STE 41N
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2733
Mailing Address - Country:US
Mailing Address - Phone:754-263-2050
Mailing Address - Fax:754-263-2052
Practice Address - Street 1:1460 NW 107TH AVE STE 41N
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:FL
Practice Address - Zip Code:33172-2733
Practice Address - Country:US
Practice Address - Phone:754-263-2050
Practice Address - Fax:754-263-2052
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022735500Medicaid