Provider Demographics
NPI:1629749007
Name:LAZZARA, MAURA (CCC-SLP, PC)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:LAZZARA
Suffix:
Gender:F
Credentials:CCC-SLP, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HUNTERS LN
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2308
Mailing Address - Country:US
Mailing Address - Phone:201-919-5956
Mailing Address - Fax:
Practice Address - Street 1:156 RT. 15 NORTH
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NJ
Practice Address - Zip Code:07848
Practice Address - Country:US
Practice Address - Phone:973-862-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00476400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist