Healthcare Provider Details

I. General information

NPI: 1013407667
Provider Name (Legal Business Name): KATHRYN RONNIE LAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 E 3RD ST
BOSTON MA
02127-2337
US

IV. Provider business mailing address

845 E 3RD ST
BOSTON MA
02127-2337
US

V. Phone/Fax

Practice location:
  • Phone: 617-721-4738
  • 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: