Provider Demographics
NPI:1053548255
Name:LAZAR, MEGAN (MFT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LAZAR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 FLORENCITA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1817
Mailing Address - Country:US
Mailing Address - Phone:818-590-8309
Mailing Address - Fax:
Practice Address - Street 1:2303 FLORENCITA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1817
Practice Address - Country:US
Practice Address - Phone:818-590-8309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34534106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist