Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 4011 | AZ |
Y | 103T00000X | Psychologist | 4011 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 4011 | AZ |
N | 103G00000X | Clinical Psychologist | 4011 | AZ |
N | 103TC0700X | Clinical Psychologist | 4011 | AZ |
N | 103TC1900X | Counseling Psychologist | 4011 | AZ |
NPI | 1225134026 |
---|---|
Provider Name | Nicole Lazorwitz |
First Address | Phoenix, AZ 85064-5396 |
Second Address | Phoenix, AZ 85013-3420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 07/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
96097 | BCBS AUXILARY (01) | NE |