Nicollette Lee Lazarides

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

513-140 Issued in WI

Practice address

4125 N 124TH St Ste a
Brookfield, WI 53005-1837

Phone

(920) 857-9041

NPI assigned

Mar 10, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Caravel Autism Health, LLC

  • Behavior Analyst
  • Green Bay, WI
  • NPI 1588993091
  NPD (past)
• Integrated Developmental Services, Inc

  • Mental Health Counselor
  • Madison, WI
  • NPI 1528025954
  NPD (past)
• Caravel Counseling and Diagnostics SC

  • Clinical Psychologist
  • Woodbury, MN
  • NPI 1780258004
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1023766995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 ALLOUEZ AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4125 N 124TH ST STE A",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530051837",
            "telephone_number": "920-857-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAZARIDES",
        "first_name": "NICOLLETTE",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-10",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "513-140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy M Lautz, M.D.
• Judy Lauwasser Bruett, LCSW
• Megan Marie Lavin, DPT
• Kerry Eva Lawrence
• Todd Emery Lawrence, MSPT
• Shannon Lebal
• Madelyn Bryn Leclair-Johnson, M.S., CF-SLP
• Loren L Lee, LPC
• Robyn C. Leflore, NP
• Legacy Physiatry Group Wisconsin, LLC

• Behavior Analyst in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Behavior Analyst in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.