| Shelley Wisdom-lazar Licensed Clinical Social Worker P.c. | |
|
445 Marine View Ave Ste 300 Del Mar CA 92014-3926 | |
| (619) 540-7811 | |
| (858) 755-2416 |
| Full Name | Shelley Wisdom-lazar Licensed Clinical Social Worker P.c. |
|---|---|
| Speciality | Social Worker |
| Location | 445 Marine View Ave Ste 300, Del Mar, California |
| Authorized Official Name and Position | Shelley Wisdom-lazar (OWNER) |
| Authorized Official Contact | 6195407811 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shelley Wisdom-lazar Licensed Clinical Social Worker P.c. Po Box 3695 Rancho Santa Fe CA 92067-3695 Ph: (619) 540-7811 | Shelley Wisdom-lazar Licensed Clinical Social Worker P.c. 445 Marine View Ave Ste 300 Del Mar CA 92014-3926 Ph: (619) 540-7811 |
| NPI Number | 1699508622 |
|---|---|
| Provider Enumeration Date | 08/23/2024 |
| Last Update Date | 08/23/2024 |
| Certification Date | 08/23/2024 |
| Medicare PECOS PAC ID | 2961934773 |
|---|---|
| Medicare Enrollment ID | O20241017004043 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699508622 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shelley S Wisdom-lazar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467725028 PECOS PAC ID: 1850619891 Enrollment ID: I20170707000885 |
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