Provider Demographics
NPI:1942748546
Name:LAZO, LISSETTE
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:LAZO
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 1:804 NE 120TH ST
Mailing Address - Street 2:
Mailing Address - City:BISCAYNE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6314
Mailing Address - Country:US
Mailing Address - Phone:305-439-3811
Mailing Address - Fax:
Practice Address - Street 1:804 NE 120TH ST
Practice Address - Street 2:
Practice Address - City:BISCAYNE PARK
Practice Address - State:FL
Practice Address - Zip Code:33161-6314
Practice Address - Country:US
Practice Address - Phone:305-439-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst