MEDICARE: VALERIA LAZO

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	149.023488	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295216133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIA LAZO

Provider Business Mailing Address
First Line	:	1023 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2913
Country	:	US
Telephone Number	:	786-302-1182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2913
Country	:	US
Telephone Number	:	786-302-1182
Fax Number	:

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	01/19/2023

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Directions to “ VALERIA LAZO ” Practice Location

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