Healthcare Provider Details

I. General information

NPI: 1588163760
Provider Name (Legal Business Name): SUZANNE GLAZER LAZARUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 GENERAL TAYLOR ST
NEW ORLEANS LA
70125-2915
US

IV. Provider business mailing address

2807 JOSEPH ST
NEW ORLEANS LA
70115-7043
US

V. Phone/Fax

Practice location:
  • Phone: 504-249-5199
  • Fax:
Mailing address:
  • Phone: 504-237-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10184
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: