Healthcare Provider Details

I. General information

NPI: 1750801965
Provider Name (Legal Business Name): ARYEH LAZAR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 07/20/2024
Certification Date: 07/20/2024
Deactivation Date: 03/31/2023
Reactivation Date: 07/15/2024

III. Provider practice location address

PO BOX 1024
ANAHEIM CA
92815-1024
US

IV. Provider business mailing address

PO BOX 1024
ANAHEIM CA
92815-1024
US

V. Phone/Fax

Practice location:
  • Phone: 949-751-6163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: