Provider Demographics
NPI:1619019080
Name:LAZARUS, VIRGINIA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:LYNN
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 HARTZELL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1123
Mailing Address - Country:US
Mailing Address - Phone:847-791-1624
Mailing Address - Fax:847-733-1217
Practice Address - Street 1:2530 CRAWFORD AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4970
Practice Address - Country:US
Practice Address - Phone:847-604-1945
Practice Address - Fax:847-733-1217
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007124103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical