Healthcare Provider Details

I. General information

NPI: 1477215960
Provider Name (Legal Business Name): ALDINE LAZARRE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 EDWARDS ST
NEW HAVEN CT
06511-3986
US

IV. Provider business mailing address

238 LIGHT ST # 1
STRATFORD CT
06614-5219
US

V. Phone/Fax

Practice location:
  • Phone: 203-772-7270
  • Fax:
Mailing address:
  • Phone: 203-360-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: