Healthcare Provider Details

I. General information

NPI: 1710094891
Provider Name (Legal Business Name): KIMBERLY JOY LAZARUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 LAKEVIEW PKWY
VERNON HILLS IL
60061-1400
US

IV. Provider business mailing address

741 CONGRESSIONAL LN
RIVERWOODS IL
60015-5704
US

V. Phone/Fax

Practice location:
  • Phone: 847-367-1611
  • Fax:
Mailing address:
  • Phone: 847-494-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: