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General NPI Number Information
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NPI Number | 1023425519
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Entity Type | Individual
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Provider Name | REGINA LAZAROVICH PHD
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Gender | Female
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 316E MOUNT HERMON RD
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City | SCOTTS VALLEY
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State | CA
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Zip | 95066-4009
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Country | US
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Telephone | 347-735-9740
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Fax |
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Provider Business Mailing Address
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Address Line | 216E MOUNT HERMON RD # 316
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City | SCOTTS VALLEY
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State | CA
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Zip | 95066-4009
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Country | US
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Telephone | 347-735-9740
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 020676
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31508
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License Number State | CA
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