Provider Demographics
NPI:1689628034
Name:ZEGER, LAWRENCE JOEL (PHD MSW LCSW BCD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOEL
Last Name:ZEGER
Suffix:
Gender:M
Credentials:PHD MSW LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 N 35TH PLACE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4708
Mailing Address - Country:US
Mailing Address - Phone:602-956-7997
Mailing Address - Fax:
Practice Address - Street 1:11020 N TATUM BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3841
Practice Address - Country:US
Practice Address - Phone:602-996-8619
Practice Address - Fax:602-996-7932
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW00261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
78336Medicare ID - Type UnspecifiedGROUP # CCP LTD
AZ78338Medicare ID - Type Unspecified