MEDICARE: NANCY LAZAR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	8101696-3501	UT

General Provider Information

NPI Number	:	1053862433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY LAZAR LCSW

Provider Business Mailing Address
First Line	:	7430 ARIZONA AVE APT 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-1390
Country	:	US
Telephone Number	:	760-505-9752
Fax Number	:

Provider Business Practice Location Address
First Line	:	7430 ARIZONA AVE APT 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-1390
Country	:	US
Telephone Number	:	760-505-9752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	09/03/2020

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