Healthcare Provider Details

I. General information

NPI: 1356531909
Provider Name (Legal Business Name): LAZAR PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W GREEN ST
MARSHALL MI
49068-1519
US

IV. Provider business mailing address

310 W GREEN ST
MARSHALL MI
49068-1519
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-0157
  • Fax: 269-781-9755
Mailing address:
  • Phone: 269-781-0157
  • Fax: 269-781-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LAZAR CLAIRE LAZAR
Title or Position: OWNER
Credential: PH.D.
Phone: 269-781-0157