Healthcare Provider Details

I. General information

NPI: 1609905504
Provider Name (Legal Business Name): MARILYN LAZAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23430 HAWTHORNE BLVD SUITE 125
TORRANCE CA
90505-4720
US

IV. Provider business mailing address

9400 OAKMORE RD
LOS ANGELES CA
90035-4139
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-0321
  • Fax: 310-378-6279
Mailing address:
  • Phone: 310-486-2718
  • Fax: 310-378-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 10803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: