Provider Demographics
NPI:1558609131
Name:LAZAR, ALLISON (BCBA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:LAZAR
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19510 VENTURA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2947
Mailing Address - Country:US
Mailing Address - Phone:818-881-1933
Mailing Address - Fax:
Practice Address - Street 1:11818 RIVERSIDE DR APT 211
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4086
Practice Address - Country:US
Practice Address - Phone:916-217-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-09-6511103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst