Provider Demographics
NPI:1841785250
Name:LAZARTE-BERKOWITZ, STEPHANIE ROSALYN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ROSALYN
Last Name:LAZARTE-BERKOWITZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ROSALYN
Other - Last Name:SURYANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 WALDEN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2504
Mailing Address - Country:US
Mailing Address - Phone:617-867-5466
Mailing Address - Fax:
Practice Address - Street 1:17 WALDEN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2504
Practice Address - Country:US
Practice Address - Phone:617-867-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 390200000X
MALMHC10000664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program