Healthcare Provider Details

I. General information

NPI: 1972084515
Provider Name (Legal Business Name): ALICE LAZARE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 07/11/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PLEASANT ST
NORTHAMPTON MA
01060-4127
US

IV. Provider business mailing address

100 W DEAN KEETON ST CAMPUS MAIL A3500 (CMHC)
AUSTIN TX
78712
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-6855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number69223
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: