Provider Demographics
NPI:1104435197
Name:CATHERINE LAZAR LLC
Entity type:Organization
Organization Name:CATHERINE LAZAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:440-561-0111
Mailing Address - Street 1:4200 BRAINARD RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1406
Mailing Address - Country:US
Mailing Address - Phone:440-561-0111
Mailing Address - Fax:
Practice Address - Street 1:20525 CENTER RIDGE RD STE 303
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3424
Practice Address - Country:US
Practice Address - Phone:440-561-0111
Practice Address - Fax:216-228-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0293309Medicaid