Healthcare Provider Details

I. General information

NPI: 1033415898
Provider Name (Legal Business Name): ANDREA MEREDITH LAZARUS MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA MEREDITH LAZARUS-MARQUEZ MA, LMFT

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W THOUSAND OAKS BLVD STE 600
THOUSAND OAKS CA
91360-4463
US

IV. Provider business mailing address

1412 OLDBURY PL
WESTLAKE VILLAGE CA
91361-1525
US

V. Phone/Fax

Practice location:
  • Phone: 805-777-3563
  • Fax:
Mailing address:
  • Phone: 818-674-1216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: