Provider Demographics
NPI:1679935985
Name:LAZARUS, AMBER DAWN (PHD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:DAWN
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:D
Other - Last Name:LAZARUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLC
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:1979 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1444
Practice Address - Country:US
Practice Address - Phone:954-428-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8979103K00000X, 103T00000X, 103TB0200X, 103TC2200X, 103TM1800X
FLPY8979103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities