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General NPI Number Information
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NPI Number | 1639664873
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Entity Type | Individual
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Provider Name | TODD LAZAR
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Gender | Male
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 2858 W DIVERSEY AVE
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City | CHICAGO
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State | IL
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Zip | 60647-1871
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Country | US
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Telephone | 312-925-6366
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Fax |
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Provider Business Mailing Address
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Address Line | 2637 N WHIPPLE ST
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City | CHICAGO
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State | IL
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Zip | 60647-1721
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149018280
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License Number State |
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