Healthcare Provider Details

I. General information

NPI: 1750783726
Provider Name (Legal Business Name): DEANNA LAZARO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 3RD AVE STE 2230
CHULA VISTA CA
91911-1350
US

IV. Provider business mailing address

3539 COLLEGE AVE
SAN DIEGO CA
92115-7032
US

V. Phone/Fax

Practice location:
  • Phone: 619-271-7992
  • Fax: 619-271-7970
Mailing address:
  • Phone: 619-818-3788
  • Fax: 619-795-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95186
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: