Healthcare Provider Details

I. General information

NPI: 1184212607
Provider Name (Legal Business Name): NICOLE LAZORWITZ PSYD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2021
Last Update Date: 01/10/2021
Certification Date: 01/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 N CENTRAL AVE STE 101
PHOENIX AZ
85012-2121
US

IV. Provider business mailing address

3507 N CENTRAL AVE STE 101
PHOENIX AZ
85012-2121
US

V. Phone/Fax

Practice location:
  • Phone: 520-428-4528
  • Fax:
Mailing address:
  • Phone: 520-428-4528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE LAZORWITZ
Title or Position: OWNER
Credential: PSY D
Phone: 520-428-4528