Healthcare Provider Details

I. General information

NPI: 1376643387
Provider Name (Legal Business Name): BEVERLY CAROL LAZAR L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CHURCH ST CRAMER HOUSE
SARATOGA SPRINGS NY
12866-1046
US

IV. Provider business mailing address

211 CHURCH ST CRAMER HOUSE
SARATOGA SPRINGS NY
12866-1046
US

V. Phone/Fax

Practice location:
  • Phone: 518-584-9030
  • Fax: 518-581-1709
Mailing address:
  • Phone: 518-584-9030
  • Fax: 518-581-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number040085R
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: