Provider Demographics
NPI:1790370278
Name:LAZAR, PATRICIA LEAH (LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEAH
Last Name:LAZAR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 CENTRO WAY
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3404
Mailing Address - Country:US
Mailing Address - Phone:141-567-3386
Mailing Address - Fax:
Practice Address - Street 1:922 CENTRO WAY
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3404
Practice Address - Country:US
Practice Address - Phone:141-567-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT23655106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist