Healthcare Provider Details

I. General information

NPI: 1255619714
Provider Name (Legal Business Name): PAULO LAZARO LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13499 BISCAYNE BLVD SUITE 208
NORTH MIAMI FL
33181-2043
US

IV. Provider business mailing address

13499 BISCAYNE BLVD SUITE 208
NORTH MIAMI FL
33181-2043
US

V. Phone/Fax

Practice location:
  • Phone: 305-206-2899
  • Fax: 954-510-2079
Mailing address:
  • Phone: 305-206-2899
  • Fax: 954-510-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5258
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW5258
License Number StateFL

VIII. Authorized Official

Name: MR. PAULO LAZARO
Title or Position: PRESIDENT
Credential: LCSW
Phone: 305-206-2899