Healthcare Provider Details

I. General information

NPI: 1346390259
Provider Name (Legal Business Name): JUDITH B LAZZARETTI M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 WESTFIELD AVE
ELIZABETH NJ
07208-1325
US

IV. Provider business mailing address

52 BRIAR HILLS CIR
SPRINGFIELD NJ
07081-3420
US

V. Phone/Fax

Practice location:
  • Phone: 908-352-1875
  • Fax: 908-352-8858
Mailing address:
  • Phone: 973-379-4147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00203900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: