Healthcare Provider Details

I. General information

NPI: 1649715277
Provider Name (Legal Business Name): KARINA LAZARIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 11/27/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 N EOLA RD SUIT A
AURORA IL
60502-9612
US

IV. Provider business mailing address

452 N EOLA RD SUIT A
AURORA IL
60502-9612
US

V. Phone/Fax

Practice location:
  • Phone: 630-999-0401
  • Fax:
Mailing address:
  • Phone: 630-999-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49489
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: