Provider Demographics
NPI:1609905504
Name:LAZAR, MARILYN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:LAZAR
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 1:9400 OAKMORE RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4139
Mailing Address - Country:US
Mailing Address - Phone:310-486-2718
Mailing Address - Fax:310-378-6279
Practice Address - Street 1:23430 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4720
Practice Address - Country:US
Practice Address - Phone:310-373-0321
Practice Address - Fax:310-378-6279
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 108031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW10803Medicare ID - Type Unspecified