Provider Demographics
NPI:1962646158
Name:ALTHEA LAZZARA PSYD LLC
Entity Type:Organization
Organization Name:ALTHEA LAZZARA PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAZZARA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:973-981-7576
Mailing Address - Street 1:48 MOUNTAINVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6766
Mailing Address - Country:US
Mailing Address - Phone:973-981-7576
Mailing Address - Fax:
Practice Address - Street 1:48 MOUNTAINVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6766
Practice Address - Country:US
Practice Address - Phone:973-981-7576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty