Healthcare Provider Details

I. General information

NPI: 1366756835
Provider Name (Legal Business Name): SANDRA MARIE LAZARRE SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 SW 30TH AVE
FORT LAUDERDALE FL
33312-6907
US

IV. Provider business mailing address

5220 SW 30TH AVE
FORT LAUDERDALE FL
33312-6907
US

V. Phone/Fax

Practice location:
  • Phone: 954-612-5693
  • Fax:
Mailing address:
  • Phone: 954-612-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: