Provider Demographics
NPI:1407537277
Name:BENAVIDES LAZO, LORENA (LCSW)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:BENAVIDES LAZO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-3327
Mailing Address - Country:US
Mailing Address - Phone:201-424-2740
Mailing Address - Fax:
Practice Address - Street 1:384 RIVER DR
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-3327
Practice Address - Country:US
Practice Address - Phone:201-424-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC061796001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical