Provider Demographics
NPI:1912293788
Name:LAZARUS, ZACHARY NATHANIEL
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:NATHANIEL
Last Name:LAZARUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5320
Mailing Address - Country:US
Mailing Address - Phone:510-545-4177
Mailing Address - Fax:
Practice Address - Street 1:2411 SANTA CLARA AVE STE 28
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4543
Practice Address - Country:US
Practice Address - Phone:510-545-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CA709701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health