Provider Demographics
NPI:1770766065
Name:LAZARO, MAIRA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MAIRA
Middle Name:
Last Name:LAZARO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 JEFFERSON ST APT 608
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1437
Mailing Address - Country:US
Mailing Address - Phone:720-937-9589
Mailing Address - Fax:
Practice Address - Street 1:2601 JEFFERSON ST APT 608
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1437
Practice Address - Country:US
Practice Address - Phone:720-937-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical