Healthcare Provider Details

I. General information

NPI: 1902221526
Provider Name (Legal Business Name): IVANA LAZIC MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FRIENDS LN
NEWTOWN PA
18940-1897
US

IV. Provider business mailing address

121 FRIENDS LN
NEWTOWN PA
18940-1897
US

V. Phone/Fax

Practice location:
  • Phone: 215-867-1876
  • Fax:
Mailing address:
  • Phone: 215-867-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006731
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: