Provider Demographics
NPI:1861939209
Name:LAZERICK, ANDREA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:LAZERICK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:FEUERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:2536 TRAYMORE RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6363 S PECOS RD STE 206
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-6293
Practice Address - Country:US
Practice Address - Phone:702-850-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty