Provider Demographics
NPI:1124520721
Name:LAZOTT, EMILY KATHRYN
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHRYN
Last Name:LAZOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 TEQUESTA DR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2514
Mailing Address - Country:US
Mailing Address - Phone:508-648-0905
Mailing Address - Fax:
Practice Address - Street 1:426 TEQUESTA DR
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2514
Practice Address - Country:US
Practice Address - Phone:508-648-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-46007103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAR54767Medicaid