Healthcare Provider Details

I. General information

NPI: 1912293788
Provider Name (Legal Business Name): ZACHARY NATHANIEL LAZARUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ZACH GRATZ-LAZARUS

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416A CENTRAL AVE STE B3 SUITE B3
ALAMEDA CA
94501-4516
US

IV. Provider business mailing address

2416A CENTRAL AVE STE B3
ALAMEDA CA
94501-4516
US

V. Phone/Fax

Practice location:
  • Phone: 510-545-4177
  • Fax:
Mailing address:
  • Phone: 510-545-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number70970
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: