Provider Demographics
NPI:1437177573
Name:LAZAR, AYLENE (MFT)
Entity Type:Individual
Prefix:DR
First Name:AYLENE
Middle Name:
Last Name:LAZAR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:AYLENE
Other - Middle Name:
Other - Last Name:LAZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 8403
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91372-8403
Mailing Address - Country:US
Mailing Address - Phone:818-346-7079
Mailing Address - Fax:818-346-7079
Practice Address - Street 1:4774 PARK GRANADA
Practice Address - Street 2:#8403
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1550
Practice Address - Country:US
Practice Address - Phone:818-346-7079
Practice Address - Fax:818-346-7079
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist