Provider Demographics
NPI:1598519936
Name:LAZAREVIC, MARIA (PHD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:LAZAREVIC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:SKOULIDAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4335 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-9711
Mailing Address - Country:US
Mailing Address - Phone:312-972-6877
Mailing Address - Fax:
Practice Address - Street 1:260 E 90TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8102
Practice Address - Country:US
Practice Address - Phone:312-972-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty