Active NPI
Brian Richard Lazzaro, PH.D.
- Clinical Psychologist
- Park Ridge, IL
National Provider Identifier
1972054104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.009356
- Practice address
- 325 S Western Ave
Park Ridge, IL 60068-3820 - Phone
- (847) 712-1445
- NPI assigned
- Oct 24, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.009356 | IL | Primary |
Addresses
Primary practice location
325 S Western Ave
Park Ridge, IL 60068-3820
Mailing address
325 S Western Ave
Park Ridge, IL 60068-3820
Phone (847) 712-1445
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.009356 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477267200000",
"number": "1972054104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 S WESTERN AVE",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600683820",
"telephone_number": "847-712-1445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 S WESTERN AVE",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600683820",
"telephone_number": "847-712-1445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAZZARO",
"first_name": "BRIAN",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-10-24",
"last_updated": "2016-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.009356",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.