Provider Demographics
NPI:1881884682
Name:LAZO, MARIA ANNA C (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARIA ANNA
Middle Name:C
Last Name:LAZO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MARIA ANNA
Other - Middle Name:
Other - Last Name:LAZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1535 RIVER PARK DR STE 2000
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4601
Mailing Address - Country:US
Mailing Address - Phone:916-286-1010
Mailing Address - Fax:
Practice Address - Street 1:1535 RIVER PARK DR STE 2000
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4601
Practice Address - Country:US
Practice Address - Phone:916-286-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25602103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent