Healthcare Provider Details

I. General information

NPI: 1861718538
Provider Name (Legal Business Name): PAUL LAZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 N STATE ROAD 7 STE 211
LAUDERDALE LAKES FL
33319-5625
US

IV. Provider business mailing address

500 S SURF RD UNIT 6
HOLLYWOOD FL
33019-2011
US

V. Phone/Fax

Practice location:
  • Phone: 954-578-6604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: