Healthcare Provider Details

I. General information

NPI: 1346776937
Provider Name (Legal Business Name): SOPHIE A. LAZARUS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ZOLLINGER RD 4TH FLOOR
COLUMBUS OH
43221-2849
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-9600
  • Fax: 614-366-1215
Mailing address:
  • Phone: 614-293-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7571
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: