Provider Demographics
NPI:1760754774
Name:LAZERWITZ, INGRID MARIE (MSSA, LSW)
Entity Type:Individual
Prefix:MS
First Name:INGRID
Middle Name:MARIE
Last Name:LAZERWITZ
Suffix:
Gender:F
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 CARNEGIE AVE
Mailing Address - Street 2:BUILDING B
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2641
Mailing Address - Country:US
Mailing Address - Phone:440-260-8930
Mailing Address - Fax:440-260-8577
Practice Address - Street 1:3500 CARNEGIE AVE
Practice Address - Street 2:BUILDING B
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2641
Practice Address - Country:US
Practice Address - Phone:440-260-8930
Practice Address - Fax:440-260-8577
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 11004281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical