Provider Demographics
NPI:1922519412
Name:LAZOS, DEMETRIA CATHERINE
Entity Type:Individual
Prefix:MS
First Name:DEMETRIA
Middle Name:CATHERINE
Last Name:LAZOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 MORRIS PARK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3751
Mailing Address - Country:US
Mailing Address - Phone:646-938-8586
Mailing Address - Fax:
Practice Address - Street 1:959 MORRIS PARK AVE APT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3751
Practice Address - Country:US
Practice Address - Phone:646-938-8586
Practice Address - Fax:646-938-8586
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist