Provider Demographics
NPI:1124123708
Name:LAZAR, JOEL DEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:DEAN
Last Name:LAZAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 ROSECRANS ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106
Mailing Address - Country:US
Mailing Address - Phone:619-540-6038
Mailing Address - Fax:619-426-1906
Practice Address - Street 1:1267 ROSECRANS ST
Practice Address - Street 2:SUITE E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106
Practice Address - Country:US
Practice Address - Phone:619-540-6038
Practice Address - Fax:619-426-1906
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12520103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY125200Medicaid
CAPSY125200Medicaid
CACP12520Medicare ID - Type Unspecified