Provider Demographics
NPI:1891260485
Name:LAZZARO PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:LAZZARO PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LAZZARO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-712-1445
Mailing Address - Street 1:36 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4059
Mailing Address - Country:US
Mailing Address - Phone:847-712-1445
Mailing Address - Fax:
Practice Address - Street 1:36 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4059
Practice Address - Country:US
Practice Address - Phone:847-712-1445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty