Provider Demographics
NPI:1346129327
Name:WILSON, LAZARA M (BSW)
Entity type:Individual
Prefix:
First Name:LAZARA
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:LAZARA
Other - Middle Name:M
Other - Last Name:ANSALONI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE
Mailing Address - State:MA
Mailing Address - Zip Code:02561-0553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1185 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-3066
Practice Address - Country:US
Practice Address - Phone:800-444-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical