Provider Demographics
NPI:1679555874
Name:LAZZARI, TAREN (CNS)
Entity type:Individual
Prefix:MS
First Name:TAREN
Middle Name:
Last Name:LAZZARI
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S CULVER ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4806
Mailing Address - Country:US
Mailing Address - Phone:770-963-1537
Mailing Address - Fax:866-373-5720
Practice Address - Street 1:230 S CULVER ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4806
Practice Address - Country:US
Practice Address - Phone:770-963-1537
Practice Address - Fax:866-373-5720
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN124270364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric